Early experience with varicella vaccination in pediatric heart transplant recipients

International consensus guidelines to vaccinate children after solid organ transplant with the live -atten-uated varicella (VZV) vaccine exclude pediatric heart transplant recipients due to insufficient evidence for safety, seroconversion rate, or adverse event profile. Caution is also recommended in the setting of mycophenolate mofetil (MMF) immunosuppression. However, VZV infection in these patients can be serious or even fatal. We report our novel early experience with VZV vaccination in a cohort of 31 children following heart transplantation, 42% of who were on MMF. The early seroconversion rate was 16/ 17 (94%) with no major adverse events. Though a rash of some description was reported in 29%, spots were few and self-resolving in 1-3 days. Select pediatric heart transplant patients can be safely vaccinated with VZV vaccine with a high early seroconversion rate and a mild adverse event profile. (c) 2022 International Society for Heart and Lung Transplantation. All rights reserved.

Automated summary

International consensus guidelines do not include pediatric heart transplant recipients in the vaccination recommendations for live-attenuated varicella (VZV) vaccine due to insufficient evidence. However, VZV infection can be serious or fatal for these patients. A study reported a high early seroconversion rate and mild adverse events in pediatric heart transplant patients who received VZV vaccination, suggesting safe vaccination is possible.