Donor-derived Kaposi’s sarcoma in a liver–kidney transplant recipient

Abstract

Human herpes virus 8 (HHV-8), also known as Kaposi's sarcoma associated herpesvirus (KSHV), is an oncogenic virus that can cause Kaposi's sarcoma (KS). KS can develop following organ transplantation through reactivation of the recipient's latent HHV-8 infection, or less commonly through donor-derived infection which has higher risk for severe illness and mortality. We describe a case of probable donor-derived KS in the recipient of a liver-kidney transplant. The donor had multiple risk factors for HHV-8 infection. The KS was successfully treated by switching immunosuppression from tacrolimus to sirolimus. With an increasing number of human immunodeficiency virus (HIV)-positive persons seeking organ transplantation and serving as organ donors for HIV-positive recipients, HHV-8 prevalence among donors and recipients will likely increase and with that the risk for post-transplant KS. Predetermination of HHV-8 status can be useful when considering organ donors and recipients with risk factors, although there are currently no validated commercial tests for HHV-8 antibody screening.

Imaging of Kaposi sarcoma

“…Hepatic KS is most commonly seen among patients with AIDS, with about 34% of cases diagnosed during autopsy [28]; however, it uncommonly presents during life. Hepatic KS has also been associated with organ transplants [29].…”

Donor-derived human herpesvirus 8 and development of Kaposi sarcoma among 6 recipients of organs from donors with high-risk sexual and substance use behavior

“…The CDC can perform HHV‐8 testing for posttransplant KS as part of HHV‐8 transplant‐transmission investigations (sdollard@cdc.gov). In addition, limited US reference laboratories offer HHV‐8 serology testing 28 …”

Successful treatment of primary donor‐derived human herpesvirus‐8 infection and hepatic Kaposi Sarcoma in an adult liver transplant recipient

“…The development of post‐transplant KS is typically attributed to reactivation of latent infection in patients that were seropositive prior to transplant; however, it can, in rare cases, occur following primary HHV‐8 infection by graft transmission from a seropositive donor to a seronegative recipient . Primary HHV‐8 KS has been reported in several small case series worldwide …”

“…4 Primary HHV-8 KS has been reported in several small case series worldwide. [5][6][7][8] This report describes the clinical course of an adult deceaseddonor split liver transplant recipient, who acquired primary HHV-8 infection from the donor and subsequently developed hepatic KS.…”