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Adverse Occurrence type:
Most recent risk assessment for non-melanoma skin cancer (Council of Europe, 2018): basal cell and squamous cell carcinoma of the skin are considered to represent minimal risk for tumor transmission. Kaposi's sarcoma, Merkel cell carcinoma, and skin sarcoma are considered to represent unacceptable risks for tumor transmission. Donors with a history of non-melanoma skin cancer are considered to represent the same risks for transmission as outlined above.
Time to detection:
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.
Suggest new keywords:
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.
Please clone record under Infection->viral->Human Herpes virus 8 (HHV-8) (and change group audience to Infections->viral for that record) MN --> OK (EP)
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.