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Adverse Occurrence type:
The rate of seroconversion observed in the study population was 25% (3/12; D+/R-)
Time to detection:
Seroconversion occurred within 6 months from transplantation but exact time point was not given for each of the 3 seroconvertors.
Alerting signals, symptoms, evidence of occurrence:
The primary goal in this Italian study was to establish a gold standard algorithm for the diagnosis and monitoring of HHV8 infection, given the limitations with serological and molecular tests. Pre-donation donor sample and serial recipients' samples were tested by 6 serological assays and 2 molecular assays. Amongst the D+/R-, 3 recipients seroconverted. Clinical aspects and timelines were not mentioned, but one liver recipient developed a HHV8-associated nonmalignant illness characterized by pleural effusions, ascites, renal failure and death. A second recipient died early in the post-transplant period of a non-HHV8 related cause and a third recipient only showed seroconversion but no associated detectable viraemia or symptoms, during the study period.
Demonstration of imputability or root cause:
The focus of the work described was on comparative evaluation of virological assays to be used in the context of solid organ transplantation. Detailed description about the potential transmissions is not available. Presumption of transmission is based on D/R serological and molecular screening results, by demonstrating recipient seroconversion in D+/R- pairs. One seropositive donor, who also had detectable HHV8 DNA in blood, seems to have transmitted HHV8 infection to 2 of 3 HHV8-seronegative recipients.
Suggest new keywords:
HHV8, organ transplant, liver transplant, seroconversion, HHV 8 antibodies, HHV8 lytic antibodies; HHV8 latent antigens; HHV8 DNA; KS, Kaposi sarcoma
Multicenter Prospective Study for Laboratory Diagnosis of HHV8 Infection in Solid Organ Donors and Transplant Recipients and Evaluation of the Clinical Impact After Transplantation. Chiereghin A, et al. Transplantation. 101(8):1935-1944, 2017 Aug
Expert comments for publication:
The work described highlights the complexity in carrying out HHV8 infection screening; limitations of assays are illustrated and must be taken into consideration when devising testing algorithms and also when interpreting results from available studies. Their data is in agreement with published literature, with an observed low incidence (1.9%) of HHV8-related disease among patients identified at risk, but with potentially high morbidity. In the correct clinical and epidemiological context, low threshold of suspicion is required for early identification of HHV8 neoplastic and nonneoplastic disease as this will trigger appropriate recipient management.