Symptomatic Pulmonary Allograft Kaposi’s Sarcoma in Two Lung Transplant Recipients

Abstract

Kaposi's sarcoma (KS) is associated with solid-organ transplantation, but is extremely rare after lung transplantation. In this report, we describe two unique cases of lung transplant recipients who developed KS in the lung allograft and were treated with sirolimus and liposomal doxorubicin. One patient survived 12 months after the diagnosis of KS; the other survived 3 months after diagnosis and was found to have concomitant EBV-negative, HHV-8-positive B-cell lymphoma. We demonstrate a partial response of pulmonary KS to reduced immunosuppression and the initiation of sirolimus in one patient, as well as an association between increasing HHV-8 viremia and progression of pulmonary KS. Our report highlights the importance of secondary malignancies in patients with transplant-related KS and supports the association between HHV-8 infection and EBV-negative PTLD.

Kaposi’s sarcoma developed after allogeneic hematopoietic stem cell transplantation

“…In our case, both the EBV PCR analysis of the patient's blood sample and Epstein-Barr encoded RNA (EBER) in situ hybridization test on his pathologic tissue were negative. Although 20-30% of PTLDs were reportedly EBV-negative and a case of HHV-8-positive PTLD has been reported (14), the typical pathological alterations of the lymph node biopsy in this case exclude the diagnosis of PTLD.…”

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“…To the best of our knowledge, there are a few cases of Kaposi sarcoma with only graft involvement and only 1 previous report with lung allograft involvement without any related symptoms. [8][9][10] The succession of this unfortunate case underlines the potential morbidity of transplant-related Kaposi sarcoma and the need to maintain a high level of suspicion for Kaposi sarcoma in this population, even in the absence of cutaneous involvement and significant initial respiratory distress.…”

Kaposi’s sarcoma in the grafted lung

“…Настоящее наблюдение представляет интерес, поскольку развитие СК в аллогенном легком после трансплантации встречается крайне редко. В доступной нам литературе мы обнаружили описание лишь 6 подобных наблюдений [13][14][15][16]. Описанное наблюдение диктует необходимость проведения скринингового серологического исследования с выявлением антител к вирусу герпеса 8-го типа среди кандидатов на трансплантацию и доноров для возможной коррекции режима иммуносупрессивной терапии с целью снижения риска развития заболевания.…”