Recombinant Zoster Vaccine Use to Prevent Recurrent Shingles in an Adolescent Renal Transplant Recipient

Shingles, a reactivation of the varicella virus, is more common in immunosuppressed patients. Children with chronic or end-stage kidney disease may not respond effectively to live varicella vaccination, making it controversial post-transplant. Antiviral treatments for shingles can be nephrotoxic, and reducing immunosuppression to enhance immune responses may risk transplant rejection. Recombinant zoster vaccine (RZV) was initially indicated for immunosuppressed adults over 50. We present a case of an adolescent who, after receiving the live varicella vaccine with an observed IgG seroconversion, developed recurrent shingles post-kidney transplant and varicella seronegative status. Antiviral treatments and reduced immunosuppression contributed to graft loss. Post-second transplant, shingles recurred, leading to off-label RZV administration while fully immunosuppressed. Following RZV, there were no rejection or shingles episodes, and strong IgG seroconversion was achieved. Following RZV treatment, guidelines regarding RZV were updated to include individuals over 19, which may potentially benefit pediatric transplant recipients.