Successful Use of Kidneys from a Deceased Donor with Active Herpes Zoster Infection

Table 1

Demographic data, clinical manifestations, treatment choices, and clinical course of recipients following transplantation with organs from donors with active VZV at organ retrieval.

ID	Age	Gender	Organ type	Recipient comorbidities	Recipient VZV serostatus	Donor presentation	Anti-VZV prophylaxis	Clinical outcome
Recipient 1	52 years	F	Kidney	Diabetes type 1	Immune	Active shingles	Acyclovir 10 mg/kg dose, then renally adjusted oral acyclovir equivalent to 800 mg PO 5 times/ days, then 400 mg PO daily/bid until 3 months posttransplant	No infectious complications at 4 months of follow-up
Recipient 2	51 years	F	Kidney	Diabetes type 1	Immune	Active shingles	Acyclovir 10 mg/kg dose, then renally adjusted oral acyclovir equivalent to 800 mg PO 5 times/ days, then 400 mg PO daily/bid until 3 months posttransplant	No infectious complications at 4 months of follow-up
Case 3 ^5	15 months	F	Heart	Dilated cardiomyopathy due to endocardial fibroelastosis	Nonimmune	Severe chickenpox 10 days prior to donation	Acyclovir 200 mg IV days then 200 mg PO tid	Fever, macular rash, vesicles, VZV IgM day 12, VZV IgG month 4. Uncomplicated recovery
Case 4 ^6	62 years	F	Lung	Diffuse bronchiectasis	Immune	VZV seropositive but no clinical varicella infection	None given prophylactically but acyclovir given when patient destabilized and identified to have VZV viremia	VZV reinfection and death

Acyclovir dosing adjusted based on evolving renal function over time.