Fatal donor-derived Kaposi sarcoma following liver transplantation

Abstract

Human herpesvirus-8 (HHV8) is a recognised precursor for a number of neoplastic and non-neoplastic processes. Immunosuppressed recipients of both solid organ and haematopoietic stem cell transplants are at risk of life-threatening lytic reactivations of HHV8-infected B-lymphocytes, primary infections after receiving grafts from HHV8-seropositive donors and more rarely by the direct transplantation of malignant Kaposi sarcoma cells seeded within graft tissue. We describe the case of an HHV8-seronegative patient with confirmed, post-orthotopic liver transplant transmission of HHV8 from a seropositive donor with quantitative evidence of viraemia and subsequent development of disseminated visceral and cutaneous Kaposi sarcoma with a rapidly fatal outcome.

Human herpesvirus 8 and Kaposi sarcoma: how should we screen and manage the transplant recipient?

“…In the recent articles, most of these donor-derived diseases after SOT were rapidly lethal if not timely recognized and adequately treated [14].…”

“…Among the most interesting new data reported in the last years, it is the importance of donor-derived HHV-8 infections, which resulted in rapidly progressive and frequently fatal disseminated HHV-8-associated disorders diagnosed as Kaposi sarcoma through biopsy of either lymph nodes or the transplanted organ, and in some cases associated with previous intermittent inflammatory symptoms [11 ▪▪ ,14]. Briefly, Dollard and colleagues reported six cases of donor-derived Kaposi sarcoma.…”

“…Surprisingly, even though the mortality in index patients was high, and overall, 14 of 22 recipients (64%) had documented HHV-8 transmission, several centre contacts responded that follow-up would not be altered except for extra vigilance of Kaposi sarcoma signs or symptoms. An additional case of donor-derived disseminated Kaposi sarcoma diagnosed 5 months after liver transplant reported the presence of intermittent constitutional/inflammatory symptoms (fever, rigors, malaise, anorexia, polymyalgia and cutaneous manifestations) and pancytopenia, suggesting co-existence in the early stages of possible inflammatory HHV-8-associated syndrome [14].…”

“…These diseases can be the result of: viral reactivation in recipients who were seropositive before transplant (Rþ), or primary infections: donor-derived infection after receiving grafts from HHV-8-seropositive donors (Dþ/R-), direct transplantation of malignant cells seeded within graft tissue or de novo infections [11 && ,12,13]. In the recent articles, most of these donor-derived diseases after SOT were rapidly lethal if not timely recognized and adequately treated [14].…”

“…This strategy probably allowed prompt treatment and favourable outcome. In the aforementioned fatal case of donor-derived HHV-8 infection 5 months after liver transplant, upon retrospective testing, the patient had detectable HHV- 14]. In these case reports, there is no mention of donor or recipients HHV-8 serostatus neither HHV-8-DNA measurements, suggesting that HHV-8-associated diseases in SOT may be under reported and/or misdiagnosed probably because of lack of awareness among clinicians and lack of availability of HHV-8 diagnostic tests.…”