Status:
Ready to upload
Record number:
2034
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Council of Europe recommendation for Kaposi sarcoma of skin and for sarcoma in general can be considered relevant and are as follows:
Most recent risk assessment for non-melanoma skin cancer (Council of Europe, 2022):
Basal cell and squamous cell carcinoma of the skin are considered minimal risk due to very rare metastases. Kaposi’s sarcoma, Merkel cell carcinoma and skin sarcoma are considered an unacceptable risk. Non-melanoma skin cancer in the donor history: Basal cell and squamous cell carcinoma of the skin are considered minimal risk due to very rare metastases. Kaposi’s sarcoma, Merkel cell carcinoma and skin sarcoma are considered an unacceptable risk.
Most recent risk assessment for sarcoma (Council of Europe, 2022):
Due to the very aggressive behavior of sarcoma, they are considered an unacceptable risk for organ donation at any stage of disease. Sarcoma in donor history: Because of the very aggressive behavior of sarcoma, they are mostly considered an unacceptable risk for organ donation. After curative treatment and a recurrence-free survival of > 5 years, sarcomas are still assumed to be associated with a high risk for transmission.
Time to detection:
4 months
Alerting signals, symptoms, evidence of occurrence:
No symptoms. Transplant was a split liver. Transplant team was notified that other recipient (pediatric recipient of left lateral segment) developed KS of liver, and HHV8 PCR on archived donor serum (19 year old Iraqi man, HIV negative, no skin lesions or adenopathy, deemed high risk due to incarceration) tested positive and pretransplant recipient serum was negative.
Demonstration of imputability or root cause:
Following notification of disease in other recipient, MRI showed multiple liver lesions in the present recipient (58 year old woman). Biopsy confirmed KS. Pretransplant serum was negative for HHV8.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case report
Deceased donor
Liver transplant
Histologic analysis
Kaposi sarcoma
Reference attachment:
Suggest references:
Fu W, Merola J, Malinis M, Lacy J, Barbieri A, Liapakis AH, et al. Successful treatment of primary donor-derived human herpesvirus-8 infection and hepatic Kaposi Sarcoma in an adult liver transplant recipient. Transpl Infect Dis. 2018:e12966.
Note:
Please clone record under Infection->viral->Human Herpes virus 8 (HHV-8) (and change group audience to Infections->viral for that record) MN
Expert comments for publication:
Lesions regressed while immunosuppression was reduced, but rejection prevented continuing this course. Liposomal doxorubicin with pegfilgrastim eventually led to resolution. Most cases of posttransplant KS arise from viral reactivation, primary infection or donor transmission is less common but should be considered, particularly in donors form higher endemic rates of infection. The authors also include a discussion of treatment options for this disorder and include a review of reported cases (not necessarily donor transmitted) with treatments and outcomes.