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Adverse Occurrence type:
Transmission rates of up to 25% have been quoted, with only a small minority of recipients going on to develop symptomatic disease. However, severe illness can occur, with high morbidity.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
DONOR: A 53-year-old Italian man was admitted to an intensive care unit because of an irreversible cerebral vascular accident; authors do not mention whether other organs were transplanted. KIDNEY RECIPIENTS: Two female patients, 46 and 45 years old, respectively, living in different Italian cities. At 20 months post-transplant they both developed violaceous elevated papules in the arms and legs. Biopsy of the lesions confirmed cutaneous Kaposi's sarcoma (KS) and detailed investigations excluded mucosal involvement. Progression was eventually halted with alteration of immunosuppression.
Demonstration of imputability or root cause:
The 100% identity of nucleotide sequence of the most variable viral region, K1 gene (with 2 hypervariable regions HVR1 and HVR2) and the presence of the same, single orf-73 type in both patients provides strong molecular evidence of organ-related transmission of HHV-8. Donor and recipients where from a country where HHV8 genotype C is common. Pre transplant serology for donor and recipients is not mentioned, hence it is not known if the recipients might have been seropositive before receiving the transplanted organs.
Suggest new keywords:
ORF-K1 ; ORF 73; polymorphism; hypervariable region; kidney transplant; KS, Kaposi sarcoma; genotype
1) Molecular evidence of organ-related transmission of Kaposi sarcoma-associated herpesvirus or human herpesvirus-8 in transplant patients. Luppi M et al. Blood. 2000 Nov 1;96(9):3279-81 2) Bottalico D, Santabosti Barbone G, Giancaspro V, Bignardi L, Arisi L, Cambi V. Post-transplantation Kaposi's sarcoma appearing simultaneously in same cadaver donor renal transplant recipients. Nephrology, dialysis, transplantation. 1997;12:1055-7
Both are short papers describing the same two cases from different angles. Not a great deal of details but the tie to presentation is of note so I decide to keep them separate from other papers so that was noticed.
Expert comments for publication:
Among populations with high HHV-8 seroprevalence, the development of posttransplant KS has been found to be mainly associated with HHV-8 reactivation. Donor derived transmission via solid organ grafts has been described, with most symptomatic cases being diagnosed within 6 months from transplant; cases have been identified up to 18 to 20 months after transplant, with proof of imputability being difficult to demonstrate unless thorough investigations are carried out. Pre transplant samples from donor and recipients are required to exclude reactivation in previously infected recipients rather than de novo, donor-derived infection. Inability to detect HHV8 DNA in the donor blood does not exclude infection as HHV8 viraemia in asymptomatic individuals is rarely documented. Molecular analysis of infecting strains from recipients of twin organs is very useful in this context, as donor strain will rarely be available for analysis.