Herpes zoster (HZ) infection is a frequent and serious complication of organ transplantation that has not been examined in the current era of immunosuppression.All solid organ transplants performed between 1994 and 1999 (n = = 869) at our center were analyzed to determine the incidence, complications and risk factors for developing HZ.The overall incidence of HZ was 8.6% (liver 5.7%, renal 7.4%, lung 15.1% and heart 16.8%). The median time of onset was 9.0 months. We observed high rates of cutaneous scarring (18.7%) and post-herpetic neuralgia (42.7%). Independent organ-specific risk factors included: female gender and mycophenolate mofetil therapy (liver), and antiviral treatment other than prolonged cytomegalovirus (CMV) prophylaxis (renal and heart). For all organs combined, induction therapy and antiviral treatment other than prolonged CMV prophylaxis were independent predictors for the development of HZ.Herpes zoster is common and results in significant morbidity for solid organ transplant recipients. Risk factors include induction therapy and antiviral drug therapy other than CMV prophylaxis. The latter variable identifies a subpopulation that is likely at increased risk of latent herpesvirus reactivation. The high first-year post-transplant incidence rate suggests immunization pretransplant, even in varicella zoster virus immunoglobulin seropositive individuals, may be preventative. Key words: Herpes zoster, infection, transplantationReceived 12 March, revised 22 July, re-revised 18 August and accepted for publication 19 August 2003Varicella zoster virus (VZV) is the most infectious of the human herpesviruses and infection is almost universal (95%) by adulthood in North American and European populations. Reactivation of latent VZV [herpes zoster (HZ) or shingles] is a painful, cutaneous eruption, dermatomal in distribution, associated with a risk of dissemination. Previously described risk factors for HZ include age, malignancy, HIV infection, organ transplantation, immunodeficiency and treatment with immunosuppressive medications (1).Herpes zoster leads to significant morbidity and its most frequent complication (2) is post-herpetic neuralgia (PHN), which is associated with persistent pain for 30 or more days after acute infection, lasting years in some cases (3). Unfortunately, immunocompromized patients tend to have the most severe complications of reactivation with a greater tendency for a prolonged course of disease (4). Severely immunocompromized patients with HZ have a risk of dissemination of up to 40%, which can result in mortality rates, despite antiviral therapy, of between 4 and 34% (5-7).Previously reported incidences vary widely (8-17) and, to our knowledge, no population-based studies have been performed that define the incidence of HZ in adult multiorgan transplant cohorts. However the following incidences have been suggested in this population: renal 3-10%, liver 5-10%, lung 8-12% and hearts 20-25% (7). Possible reasons for this variation include center effect, the immunosuppressive drug ...

SUMMARY BackgroundPatients with biliary disease make retroviral antibodies and the Human Betaretrovirus has been characterized in patients with primary biliary cirrhosis.

Osteopenia/osteoporosis is common in advanced liver disease. Low serum IGF-1 is weakly predictive but serum cytokine and MELD score fail to predict the severity of bone disease.