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

Abstract

Purpose of review HHV-8-associated diseases are rare but potentially fatal in transplant recipients. Important differences exist in the distribution of HHV-8 seroprevalence, which might contribute to the lack of uniform approach to HHV-8. The aim of this review was to discuss recent updates in screening and management of HHV-8 after transplant. Recent findingsIncreasing attention has been given to the nonmalignant but potentially fatal inflammatory syndrome caused by HHV-8 in solid organ transplant (SOT) recipients. At-risk groups include HHV-8-IgG Dþ/Rtransplant and HHV-8-positive recipients. Severe cases of donor-derived HHV-8 disease, mainly Kaposi sarcoma, frequently without skin involvement and some diagnosed at autopsy, highlight the need to increase clinicians' awareness, to implement effective preemptive strategies and to perform rapid diagnosis. In HSCT setting, HHV-8-associated disorders are very rare.

Tumors after kidney transplantation: a population study

“…Although screening for HHV-8 has not been routinely included in the pre-transplant guidelines and currently available serological tests are not optimal for variable sensitivity and specificity, the identification of high-risk patients would allow for careful post-transplant follow-up [ 41 , 42 ].…”

Kaposi sarcoma in three pediatric liver transplantation recipients

“…There are four recognized subtypes of KS: the classic form; the endemic form (in sub‐Saharan Africa); the epidemic in patients with human immunodeficiency virus (HIV); and the iatrogenic subtype affecting medically immunosuppressed patients, such as those who have undergone transplantation 5,6 . KS after solid organ transplantation (SOT) is 200 times more frequent than in the general population 7 …”

“…5,6 KS after solid organ transplantation (SOT) is 200 times more frequent than in the general population. 7 Regardless of the epidemiologic variant, KS occurs in patients infected with human herpesvirus-8 (HHV8), as primary infections or viral reactivations. 7 Other neoplastic HHV8-associated disorders, with poor prognosis and rarely reported, are two lymphoproliferative diseases: multicentric Castleman's disease and primary effusion lymphoma.…”

“…7 Regardless of the epidemiologic variant, KS occurs in patients infected with human herpesvirus-8 (HHV8), as primary infections or viral reactivations. 7 Other neoplastic HHV8-associated disorders, with poor prognosis and rarely reported, are two lymphoproliferative diseases: multicentric Castleman's disease and primary effusion lymphoma. 2,6 In the last years, nonneoplastic HHV8-associated forms have been described, such as clinical conditions with fever, bone marrow failure, hepatitis (eventually with hemophagocytic lymphohistiocytosis), and Kaposi Inflammatory cytokine syndrome (KICS).…”

“…2,6 In the last years, nonneoplastic HHV8-associated forms have been described, such as clinical conditions with fever, bone marrow failure, hepatitis (eventually with hemophagocytic lymphohistiocytosis), and Kaposi Inflammatory cytokine syndrome (KICS). 7 Although HHV8 is the etiologic agent responsible for all types, the exact triggers that allow it to progress to KS remain unknown. 8 Unlike in adults, KS is rare in children and has an increased risk of disseminated and progressive disease.…”