Pediatric post‐transplant hepatic kaposi sarcoma due to donor‐derived human herpesvirus 8

Abstract

In areas of the world where human herpesvirus 8 (HHV‐8) is endemic, Kaposi sarcoma (KS) is a common SOT‐associated cancer. In the United States, where the virus is not prevalent, PTKS is rare, and there is little literature on pediatric PTKS. We present a North American female who underwent deceased donor, left lateral segment liver transplant for biliary atresia at age 11 months. The donor was a male with no known history of KS, originally from an HHV‐8‐endemic country. Three months after transplantation, the patient developed liver nodules and portal vein thrombosis. Analysis of needle biopsy established the diagnosis of KS and confirmed that the transformed cells were donor‐derived. HHV‐8 viremia was detected, and ganciclovir dosing (which had been started prophylactically) was increased. Immunosuppression was changed from tacrolimus to sirolimus. After further disease progression, 8 cycles of paclitaxel were administered. Under this treatment, her nodules regressed, HHV‐8 viremia resolved, and she had marked clinic improvement. Notably, the adult recipient of the right liver lobe from the same donor also developed PTKS. This is one of few pediatric PTKS cases described in the literature. It contributes to the mechanistic understanding of PTKS development, illustrating the risk posed by donors from HHV‐8‐endemic countries, as well as the potential for strong PTKS correlation between multiple recipients of organs from a single shared donor.

Use of Paclitaxel to Successfully Treat Children, Adolescents, and Young Adults with Kaposi Sarcoma in Southwestern Tanzania

“…This cohort also experienced a reassuring safety profile with paclitaxel, as no patients experienced neurotoxicity or paclitaxel-induced anaphylaxis or severe allergic reactions, and other side effects were seen infrequently. The favorable safety profile seen in this pediatric cohort reassuringly was in line with other pediatric case reports that safely used paclitaxel to treat KS in low- [16], middle- [30], and high-income [31] settings, and to treat other pediatric cancers [32,33]. Similarly, in a large randomized controlled trial of adults with HIV associated KS in LMIC, paclitaxel was well tolerated with a favorable safety profile [15].…”

Infiltrating Kaposi sarcoma presenting as acute kidney injury: An unexpected consequence of deliberate hepatitis C–positive organ transplantation

“…In a retrospective analysis of 244,964 SOT recipients from 1987‐2014 in the US, there were only 163 reported cases of KS (0.07%) 19 . Although most cases of post‐transplant KS are from viral reactivation, multiple studies have documented the seroconversion of HHV‐8 seronegative transplant recipients following transplant from a seropositive donor 29‐31 . Seroconversion rates for kidney recipients range from 2.1% to 12.1%, with rates of KS as high as 12.5% among seroconverted patients 4,27,32,33 …”

Not only a small liver - The pathologist’s perspective in the pediatric liver transplant setting

“…Regarding infectious (viral) induced neoplastic disorders, two pathogens are particularly noteworthy: HHV8 and EBV. HHV8 leads to the development of Kaposi sarcoma, a malignant vascular tumor, fortunately only rarely reported in the PLTx setting 72 . Similarly, EBV has been associated with induction of uncontrolled cell proliferation, particularly of B-cells, leading to the development of posttransplant lymphoproliferative disorder (PTLD) 73 .…”