Abstract
In solid organ transplant recipients (SOTRs), the oncogenic virus human herpesvirus-8 (HHV-8) also named Kaposi sarcoma herpesvirus (KSHV) causes four clinical diseases: Kaposi Sarcoma, Primary Effusion Lymphoma, Multicentric Castleman Disease (MCD), and KSHV inflammatory cytokine syndrome (KICS). This review outlines these clinical scenarios and discusses their management. Although HHV8 related disease in SOTR was first described more than three decades ago, there is a lack of data on treatment so much of the guidance is based on evidence in other immunodeficient patients, particularly people living with HIV. Whilst reduction of immunosuppression and switch from calcineurin inhibitors to mTOR inhibitors may be sufficient in early stage post-transplant KS, systemic chemotherapy is necessary for advanced stage KS and in KSHV related lymphomas. For MCD and KICS,which usually follow primary HHV-8 infection, rituximab based immunochemotherapy regimens are the cornerstone of treatment for these potentially lethal diseases. Although HHV-8 infection in SOTR is well recognised it remains under reported and greater awareness of the different clinical presentations of HHV-8 in this context is fundamental to improve outcomes.
Overview
- The study reviews the clinical scenarios of human herpesvirus-8 (HHV-8) in solid organ transplant recipients (SOTRs) and discusses their management.
- HHV-8 causes four clinical diseases in SOTRs: Kaposi Sarcoma, Primary Effusion Lymphoma, Multicentric Castleman Disease, and KSHV inflammatory cytokine syndrome.
- The management of HHV-8 related diseases in SOTRs is often based on evidence from other immunodeficient patients, particularly people living with HIV, due to a lack of data specifically in SOTR.
Comparative Analysis & Findings
- Treatment options vary depending on the stage and type of HHV-8 related disease, with reduction of immunosuppression and switch to mTOR inhibitors being sufficient for early stage Kaposi Sarcoma, but systemic chemotherapy being necessary for advanced stage KS and KSHV related lymphomas.
- Rituximab-based immunochemotherapy regimens are the cornerstone of treatment for Multicentric Castleman Disease and KSHV inflammatory cytokine syndrome.
- There is a need for greater awareness of the different clinical presentations of HHV-8 in SOTRs to improve outcomes.
Implications and Future Directions
- Further research is needed to generate data specifically on the treatment of HHV-8 related diseases in SOTRs, in order to improve management and outcomes.
- Increased awareness and reporting of HHV-8 infections in SOTRs may help to improve diagnosis and treatment, and reduce the burden of these potentially lethal diseases.
- Future studies could investigate novel therapies and treatment combinations for HHV-8 related diseases in SOTRs, particularly in the context of immune suppression and immunomodulatory therapies.