Successful treatment of primary donor‐derived human herpesvirus‐8 infection and hepatic Kaposi Sarcoma in an adult liver transplant recipient

Fu, Whitney; Merola, Jonathan; Malinis, Maricar; Lacy, Jill; Barbieri, Andrea; Liapakis, AnnMarie; Mulligan, David C.; Yoo, Peter S.

doi:10.1111/tid.12966

Cited by 11 publications

(6 citation statements)

References 36 publications

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“…To our knowledge, this is the first described use of H3K27me3 staining to determine origin of cells in a transplant recipient. Remarkably, through communication with our regional OPO, we learned that the recipient of the other portion of the liver from the same organ donor has also developed PTKS in his transplanted organ (published separately by this patient's clinical site) . To our knowledge, recipients of other organs from the same donor have not developed PTKS.…”

Section: Casementioning

confidence: 99%

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

Ocwieja

Vargas

Elisofon

et al. 2019

Pediatric Transplantation

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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.

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Section: Casementioning

confidence: 99%

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

Ocwieja

Vargas

Elisofon

et al. 2019

Pediatric Transplantation

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“…In KS with only skin involvement, local therapy can include excision, radiation therapy, cryotherapy, and laser therapy. Chemotherapy including single‐agent liposomal anthracyclines (doxorubicin and daunorubicin) and single‐agent paclitaxel has been used, especially in advanced or visceral KS . Finally, mTOR inhibitors are an option in transplant recipients since they have anti‐proliferative properties that may be useful in the treatment of KS and other angiogenic proliferative diseases .…”

Section: Discussionmentioning

confidence: 99%

“…An alternative strategy, employed in an attempt to lessen the potential for allograft loss, is the replacement of calcineurin inhibitors with anti‐proliferative mTOR inhibitors such as sirolimus . Advanced disease often requires chemotherapeutic agents, including liposomal doxorubicin, taxane, etoposide, vinblastine or gemcitabine …”

Section: Introductionmentioning

confidence: 99%

An unusual case of Kaposi sarcoma masquerading as cystitis in a kidney transplant recipient

Nair

Sheikh

Hirschwerk

et al. 2019

Transplant Infectious Dis

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“…A majority of PT-KS lesions involve skin of the extremities and trunk and mucosal surfaces of gingiva, and hard and soft palates and has been associated with cutaneous squamous cell carcinoma (131,132,162). Visceral involvement occurs in 10% of PT-KS, with 50% occurring in liver transplant recipients which may directly involve the allograft (163). Mortality rates up to 60% have been described (164).…”

Section: Accepted Articlementioning

confidence: 99%

Human herpesvirus 6, 7, and 8 in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Madan

Hand

2019

Clinical Transplantation

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These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of HHV‐6A, HHV‐6B, HHV‐7, and HHV‐8 in the pre‐ and post‐transplant period. The majority of HHV‐6 (A and B) and HHV‐7 infections in transplant recipients are asymptomatic; symptomatic disease is reported infrequently across organs. Routine screening for HHV‐6 and 7 DNAemia is not recommended in asymptomatic patients, nor is prophylaxis or preemptive therapy. Detection of viral nucleic acid by quantitative PCR in blood or CSF is the preferred method for diagnosis of HHV‐6 and HHV‐7 infection. The possibility of chromosomally integrated HHV‐6 DNA should be considered in individuals with persistently high viral loads. Antiviral therapy should be initiated for HHV‐6 encephalitis and should be considered for other manifestations of disease. HHV‐8 causes Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman disease and is also associated with hemophagocytic syndrome and bone marrow failure. HHV‐8 screening and monitoring may be indicated to prevent disease. Treatment of HHV‐8 related disease centers on reduction of immunosuppression and conversion to sirolimus, while chemotherapy may be needed for unresponsive disease. The role of antiviral therapy for HHV‐8 infection has not yet been defined.

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Successful treatment of primary donor‐derived human herpesvirus‐8 infection and hepatic Kaposi Sarcoma in an adult liver transplant recipient

Cited by 11 publications

References 36 publications

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

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

An unusual case of Kaposi sarcoma masquerading as cystitis in a kidney transplant recipient

Human herpesvirus 6, 7, and 8 in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

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