Kaposi's Sarcoma in Lung Transplantation: A Decade's Single-Centre Case Series

Purpose Human herpes virus 8 (HHV8) is associated with Kaposi's sarcoma, multicentric Castleman's disease and Primary Effusion Lymphoma. Behaving as an opportunistic virus, immune-compromised patients, including solid organ transplant recipients, are disproportionately affected. The aim of our study was to review all the cases of HHV8 related disease in our lung transplant population. Methods We retrospectively evaluated the incidence of KS and HHV8 associated lymphoproliferative disorders among all lung transplant recipients at our centre, from January 2008 to December 2017. Clinical data of these patients were collected, taking into account time of onset, donor/recipient HHV8 serology, treatments and outcomes. Results Four out of 203 (2%) patients developed KS (Table 1). Disseminated forms of KS occurred through HHV8 infection from a seropositive donor (D+/R-); both patients initially complained of aspecific symptoms (fever and malaise) and presented with pancytopenia and very high HHV8 DNAemia. We observed a very aggressive progression of KS, and patient 3 died 4 weeks after the fourth dose of liposomal doxorubicin due to an untreatable mycotic infection. By contrast, KS due to viral reactivation (i.e., D-/R+) was milder, limited to the skin and responded to modifications in the immunosuppressive regimens. Interestingly, the recipient of the liver harvested from patient 4’s donor developed another serious HHV8 related disease (i.e., Castelman's disease, investigation currently ongoing at another transplant centre). Conclusion We suggest implementation of D/R serological screening for HHV-8 before transplantation, in order to identify patients at risk of developing HHV-8 related diseases, improve clinical and virological surveillance and possibly individualize immune-suppressive therapy. For the time being, in the absence of a systematic screening, we strongly recommend to report index cases as soon as possible to regional allocation systems in order to identy other recipients potentially at risk.