COMPLICATIONS - INFECTIONS

A. Kaul
Nephrology, sgpgims,lucknow,india, lucknow/INDIA

Body:
Introduction -Chickenpox in adult renal transplant recipients, however, has received little attention,although reports have suggested that it may follow a particularly virulent course frequently requiring hospitalization and may have severe or even fatal consequences. It causes severe complications ranging from allograft rejections ,hepatitis ,pancreatitis ,pneumonia and death.Methods- To evaluate the incidence ,severity and complications of a vaccine preventable Varicella infection in renal transplant recipients we conducted a retrospective analysisof all renal transplant recepient who underwent live related renal tarnsplant and were on regular follow up at Sanjay Gandhi Post Graduate Institute Of Medical Sciences ,Lucknow ,India from June2000-June 2009 and to develop successful protocol for prevention and management of varicella in this cohort of immunosupressed population .results-18 Patients were diagnosed to have varicella infection among 1248 patients transplanted during this 10 years period from june 2000-June 2009 with Median age of patients being 39 years (range 21-54 years). Most of these patients presented with localized lesions73.3%)vesicular eruptions with hemorrhagic eruptions was observed in 6.6% . November to Februrary months constituting the major outbreaks in 66.6% Cyclosporine + Mycophenolate +Prednisolone protocolwas followed in 86.6%. All the patients were on mycophenolate mofetil therapy. 80% suffered with varicella infection during the peak ofimmunosupression protocol ie < 6 months post transplant with 33.3% within 15 days during KTU stay. Late infections beyond 5 years was observed in 2 ie 13.3%. All except 1 had stable graft functionbefore the exposure to varicella infection but 4 patients observed graft dysfunction following the infections 2 were serious and severe enough to have led the patients to dialysis dependency. 2 hadmilder graft dysfunction. There is increased mortality risks of around 13.3% in this suspectible individuals with 6.6% presenting with sepsis secondary infection and pneumonia while another 6.6%presented with encephalitis with fatal bilateral pneumonia. 66.6% presenting with various presentation superinfections,orchitis,pancreatitis,encephalitis and gastritis was obsereved in 6.6% patients each . 12.2% had presented with pneumonitis requiring admission and management.All patients were managed with IV acyclovir .1patient was given a course of 2 weeks of acyclovir and on stopping the therapy he developed fulminant disseminated varicella infection which had to be treated with IV ganclovir and hisimmunosupression was curtailedCyclosporine,azathioprine and prednisolone and oral ganclovir was continued for 3 months . this otherwise a benign disease with largely stable course but has severe overturns in the immunocompromised patients accounting for nearly 90% with significantmorbidity and mortality in nearly 13.3% patients infected highlighting the significance of pretransplant vaccination in this subgroup of population. Conclusion-Thus

Disclosure: All authors have declared no conflicts of interest.