Background:

Kaposi's Sarcoma (KS), a tumor derived from the oncogenic virus human herpesvirus-8 (HHV8) is strongly associated with immunodeficiencies. Classically seen with AIDS, it can also rarely present after solid organ transplantation (SOT) and can be donor-derived. Potential donor-derived transmission events reported to DTAC are reviewed and classified according to disease transmission likelihood. To better understand transmission of HHV8/KS and to consider mitigation strategies, all KS cases reviewed by DTAC over 10 years were analyzed.

Methods:

13 cases of KS were reviewed by DTAC between 01/2007 and 11/2016. Cases were classified based on compatible recipient pathology findings, as well as available donor and recipient serology and NAT testing. OPTN Post-Transplant Malignancy forms were reviewed for additional cases.

Results:

Proven or probable donor-derived HHV8 infection occurred in 7 recipients from 5 deceased donors; 1 donor transmitted HHV8 to 3 recipients. Possible donor-derived HHV8 occurred in an additional 3 recipients from 3 donors, with KS shortly after transplant. 5 cases of HHV8/KS were felt to be recipient-derived.

Considering the 8 donors who transmitted proven/probable/possible (p/p/p) HHV8, all but one was born overseas or had a history of higher risk sexual exposure. Three of 4 lung recipients developed disease compared to 5/8 liver, 4/10 kidney and 0/3 heart recipients. All developed KS in or adjacent to their transplanted organ; only 2 had cutaneous manifestations. Median time to develop KS in p/p/p cases was 7 months (IQR 6.5 – 8.75m), and all occurred within a year of SOT. Recipient-derived KS also presented early, (median 7.5m after SOT).

Conclusion:

The DTAC case series highlights both donor and recipient-derived HHV8 infection and demonstrates the relatively early development of KS. Kaposi's Sarcoma often developed in the transplanted organ and can clinically mimic PTLD. Although the numbers are small, it appeared proportionally more often in lung and liver recipients, perhaps due to greater lymphoid tissue transfer with these organs. HHV8 is not part of required donor testing; however, as transplantation of HIV-positive donors becomes more common via the HOPE Act, and as the use of donors born overseas also potentially expands (currently 3.1% of donors are non-US citizens), consideration for selective donor testing may be of value to individualize recipient risk.

CITATION INFORMATION: Nalesnik M, Clark M, Tlusty S, Michaels M, Wolfe C. 10 Years of DTAC Experience with Kaposi's Sarcoma – Not Just Another PTLD! Am J Transplant. 2017;17 (suppl 3).

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