Pediatric post‐transplant Kaposi sarcoma

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Rare in non-endemic areas.
Time to detection: 
Three months
Alerting signals, symptoms, evidence of occurrence: 
North American 11-month old female received the left lateral segment of the liver from a deceased donor. The donor was a male with no known history of KS, originally from an HHV‐8‐endemic country (Iran). At 3 months post transplant, liver nodules and portal vein thrombosis were detected; a needle biopsy established the diagnosis of KS and confirmed that the transformed cells were donor‐derived. HHV‐8 viremia was detected, and due to disease progression, 8 cycles of paclitaxel were administered, with response.
Demonstration of imputability or root cause: 
Retrospective serology revealed D+/R-. The adult recipient of the right liver lobe from the same donor also developed post transplant KS. Authors mention that other recipients remained well but do not give details.
Imputability grade: 
3 Definite/Certain/Proven
Suggest new keywords: 
HHV-8, post transplant KS, Kaposi sarcoma, pediatric, donor-derived
Suggest references: 
OcwiejaKE, et al. Pediatric post‐transplant hepatic kaposi sarcoma due to donorderived human herpesvirus 8. Pediatr Transplant. 2019 Mar 6:e13384
Expert comments for publication: 
The authors discuss the utility and possible strategy for determination of D/R HHV8 serostatus. Given the very low prevalence of HHV‐8 in non-endemic areas, they mention a stratified screening approach in which donors and recipients are assessed for HHV‐8 infection risk based on exposure history. This strategy has been put forward for many years, eg. see Marcelin AG, et al [Fatal disseminated Kaposi's sarcoma following human herpesvirus 8 primary infections in liver-transplant recipients 2004;10(2):295)] and comments on Notify record n.2012.