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Post transplatation lympholiferative disorders are an emergent complication of organ transplantation occurring in 2% to 10% of transplanted patient's(1). HHV-8 infection has been reported in kidney, liver, bone marrow and more recently lung transplants. - It has been reported that as high as 13% of renal transplant patients infected with HHV-8 go on to develop KS(2).
- The exact reasons for the high incidence of KS in kidney transplantation are still unknown. In one recent study it was found that the presence of HHV-8 antibodies before and after transplantation was highly predictive of the emergence of posttransplantation KS and conferred a 28-fold increased risk of KS(3).
- Aside from reactivation, HHV-8 infection during transplantation can also be as a result of viral transmission via the donor organ. A recent study from Switzerland on 220 renal transplant patients' shows 25 of these patients seroconverted for HHV-8 within a year of the transplant, 2 of which developed KS within 26 months of the transplant. Serum from 6 of the donors to the seroconverting patients was available and 5 of these were sero positive for HHV-8(4).
It seems evident that Kaposi's sarcoma can develop in transplant recipient's after either primary infection with HHV-8 or reactivation of the virus. As a result, monitoring transplant recipient's for antibodies to HHV-8 should be carried out before and after the transplant. The virus can be treated with the antiviral drugs Ganciclovir and Foscarnet(5). References: - Dotti et al. Primary effusion lymphoma after heart transplant: a new entity associated with human herpesvirus-8.
Kent Sepkowitz. Infectious disease of America. 37th Annual Meeting Day 3- November 20, 1999.
- Farge et al. Human herpesvirus-8 and other risk factors for Kaposi's sarcoma in kidney transplant recipients.
N. Regamey, M.D., et al New England Journal of Medicine 339:1358-63, November5, 1998.
- H. Balfour M.D. Antiviral Drugs. Vol 340 No 16 1255-1267.
Links of Interest: The National Cancer Institute:
http://www.nci.nih.gov/cancerinfo/pdq/treatment/kaposis/patient/ Cancer Backup:
http://www.cancerbacup.org.uk/Cancertype/Kaposissarcoma American Cancer Society:
http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_is_kaposis_sarcoma_21.asp?sitearea=cri Treatment of post-transplant Kaposi's Sarcoma:
http://www.blackwell-synergy.com/links/doi/10.1034/j.1600-6143.2002.20911.x/abs/ Pathophysiological features in transplant recipients:
http://www.blackwell-synergy.com/links/doi/10.1111/j.1525-1594.2004.00019.x/abs/;jsessionid=cHiS2N8db6N |
