Disseminated varicella infection in pediatric renal transplant recipients treated with mycophenolate mofetil

Background. Mycophenolate mofetil (MMF) is a new immune suppressive agent, effective in the prevention of acute rejection after renal transplantation. Methods. The study was a retrospective review of records of pediatric renal transplant recipients from 1985 to the present. Results. Since October 1995, the immune suppression protocol for pediatric renal transplant recipients at Mayo Eugenio Litta Children's Hospital has i ncluded MMF, prednisone, and cyclosporine A, During that time, 19 children and adolescents have received renal allografts, 17 of whom were seropositiv e for varicella antibody before transplantation, while 2 were seronegative. Varicella infection occurred in 3 of 19 patients (15.8%), all 3 of whom ha d serologically documented immunity to varicella virus before transplantati on. All episodes occurred within 12 months of transplantation. All had gene ralized vesicular lesions without dermatomal distribution. None of the pati ents developed fever, respiratory, mucocutaneous, or central nervous system manifestations. All were managed with oral acyclovir, and had an uncomplic ated recovery without neuralgia, By contrast, of 74 consecutive patients tr ansplanted before use of MMF, only 1 patient (1.4%) had varicella infection after transplantation (P=0.026). Conclusion. The enhanced immunosuppression achieved with MMF appears to be associated with increased susceptibility to varicella infection.