Human Herpesvirus 8 Causes a Wide Spectrum of Disease in Liver Transplant Recipients and May be Donor Derived: Case Series and Systematic Review of an Emerging Challenge.
Karen M J Waller, Sudarshan Arvind, Simone I Strasser, Ken Liu, Geoff W McCaughan, David G Bowen, Madeleine Gill, Rebecca Davis, William Rawlinson, Sacha Stelzer-Braid, Geoff Watson, Vinay Vanguru, Tina Marinelli
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引用次数: 0
Abstract
Background: Human herpesvirus 8 (HHV8), also known as Kaposi sarcoma (KS)-associated herpesvirus, can cause severe disease in liver transplant (LT) recipients, be donor-derived, and present variably. We describe HHV8 disease post-LT.
Methods: HHV8 disease was identified post-LT in New South Wales (NSW), 2017-2024, and from systematic review. Reports were compared by suspected donor-derived infection (DDI) and disease manifestation, using chi-square and t-tests. Survival was investigated with Cox proportional hazards.
Results: Of 188 records, 79 publications (131 cases) were included, plus four NSW cases (n = 135). Median onset was 7 months posttransplant (IQR: 5-13), with 33% suspected DDI. After median 12 months of follow-up, 68/125 had disease remission/regression; 59/135 died (49 HHV8-related). In NSW, Case 1 was proven DDI: visceral KS, 6 months post-LT; complete remission occurred with immunosuppression modification and chemotherapy. Case 2 was probable DDI: KS, multicentric Castleman's disease, and hemophagocytic lymphohistiocytosis, 3 months post-LT; the patient died despite immunosuppression modification, hydrocortisone and rituximab. Case 3 was possible DDI: KS-herpesvirus-induced cytokine syndrome, 6 months post-LT; died despite immunosuppression modification and ganciclovir. Case 4 was unlikely DDI: visceral KS, 5 months post-LT; complete remission occurred with surgery and immunosuppression modification. Survival was worse with visceral KS and non-KS disease (aHR 5.83 and 4.32, p = 0.002). Reduced immunosuppression, mTORi, and chemotherapy improved survival (aHRs 0.53, 0.36, 0.43; p = 0.006, 0.044, and 0.030). Treatment effects diverged by KS and non-KS disease. Donor screening identified more KICS and DDI, with improved non-KS disease survival.
Conclusion: Post-LT HHV8 disease is heterogeneous, with high mortality. Targeted treatments and possibly donor screening improve survival.
期刊介绍：
Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal.
Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.
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