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Adverse Occurrence type:
In this single centre study peformed in France (non-endemic area) between 1999 and 20011, 3.3% of donors and 2.5% of recipients tested positive for HHV8 antibody (LANA). In D+/R- pairs, they saw a 100% transmission rate with 50% symptomatic disease, (2 out of 4 patients) leading to death.
Time to detection:
One to six months
Alerting signals, symptoms, evidence of occurrence:
Donors and recipients were screened for antibodies to HHV8 latent antigen (latency-associated nuclear antigen, LANA) on the day of transplant to determine their serostatus. Four out of 122 donors tested positive for LANA Ab and donated livers to seronegaive recipients. Seroconversion was documented in all 4 recipients but 2 remained well during follow up of up to 2 to 3 years. The other two recipients developed symptoms between 1 and 5 months post transplant. Presentation was different and included fever, rash, lymphadenopathy, hepatitis. Bone marrow showing absence of erythroblasts, normal megakaryocytes. Lymph node biopsy showed massive haemorrhagic necrosis and capsular spindle cells were positive for HHV-8. HHV-8 DNA detected in plasma, PBMC, lymph node, bronchoalveolar lavage. Post mortem studies revealed HHV-8 positive and CD20 positive large-cell lymphoproliferation with high plasmacytoid differentiation in pulmonary, splenic, and gastric samples.
Demonstration of imputability or root cause:
Pre and post tranplant serology in donors and recipients established serostatus and seroconversion in recipients without risk for HHV8 infection, in a non-endemic country. As HHV8 sequences cannot usually be obtained from asymptomatic donors, D/R strains cannot be compared. It is not clear whether other organs were transplanted to other recipients and the outocome in these recipients. Had there been cases in recipients from common donors, imputability would have been proven. Given the epidemiology of HHV8 infection, donor derived transmisison in these cases is hghly likely.
Suggest new keywords:
HHV-8, Kaposi sarcoma, spindle cell, LANA, fever, rash, lymphadenopathy, hepatitis
Marcelin AG, Roque-Afonso AM, Hurtova M, et al. Fatal disseminated Kaposi's sarcoma following human herpesvirus 8 primary infections in liver-transplant recipients. Liver transplantation 2004;10:295-300.
Expert comments for publication:
The authors discuss the utility and rationale for serological screening of D/R where a risk of exposure exists, in order to inform recipient management. This topic is still debated today, given the difficulty in performing accurate HHV8 serology and test availability. Various studies illustrate the higher risk of primary HHV8 infection in liver recipients, with significant morbidity. This study indicates 100% seroconversion, which is higher than other publications, and could possibly be due to test specificity. Importantly, amogst those who get infecetd and go on to manifest disease, this usually happens within the first 6 months post transplant and can be fatal. Cases with onset of illness in the second year post transplant have also been described. Notify records 1827, 1828, 1829, 1879 also deal with HHV8 in solid organ transplantation.