Recombinant Zoster Vaccine Used 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 FDA-approved for immunosuppressed adults over 50. We present a case of an adolescent who, after receiving the live varicella vaccine with 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. Post-RZV, there were no rejection or shingles episodes, and strong IgG seroconversion occurred. Following RZV treatment, the Advisory Committee on Immunization Practices revised guidelines in 2021 to include RZV for adolescents over 19, potentially benefiting pediatric transplant recipients.