Mularoni Alessandra, Cona Andrea, Bulati Matteo, Busà Rosalia, Miele Monica, Timoneri Francesca, Di Bella Mariangela, Castelbuono Salvatore, Barbera Floriana, Di Carlo Daniele, Volpe Lorenzo, Gallo Alessia, Maria de Luca Anna, Coniglione Giulia, Todaro Francesca, Barozzi Patrizia, Riva Giovanni, Pietrosi Giada, Gruttadauria Salvatore, Bertani Alessandro, Vitulo Patrizio, Fontana Alessandra, Cipriani Manlio, Rizzo Sergio, Arcadipane Antonio, Luca Angelo, Mikulska Malgorzata, Conaldi Pier Giulio, Grossi Paolo Antonio, Luppi Mario
Unit of Infectious Diseases and Infection Control, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT-IRCCS), Palermo, Italy.
Unit of Infectious Diseases and Infection Control, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT-IRCCS), Palermo, Italy.
Am J Transplant. 2025 May;25(5):1070-1085. doi: 10.1016/j.ajt.2024.11.013. Epub 2024 Nov 16.
Kaposi sarcoma (KS) herpesvirus/human herpesvirus-8 (HHV-8) neoplastic and nonneoplastic disease in solid organ transplant recipients can be life-threatening. We evaluated the seroprevalence of HHV-8 infection among donors (D) and recipients (R), the incidence of HHV-8 transmission/reactivation, and the clinical characteristics, management, and outcomes of HHV-8-related diseases, including KS herpesvirus-associated inflammatory cytokine syndrome (KICS), in consecutive SOT patients from 2011 to 2023. HHV-8 seroprevalence was 3.3% in 1349 donors and 8.4% in 1856 recipients screened (P < .0001). In the D+/R- group (n = 49), 13 patients developed HHV-8-related diseases: 7 liver recipients had KICS, and 1 lung recipient had KS with subsequent KICS. Four KICS patients treated with rituximab survived, whereas the 3 patients not treated with rituximab died. Within the D-/R- group, of 5 (0.3%) patients with non-donor-derived primary HHV-8 infection, 3 liver recipients developed KICS. Of the R+ patients (n = 155), 3 developed KS. In our cohort, 25/944 (2.6%) liver transplant recipients had a primary HHV-8 infection, and 10 of them (40%) developed KICS; 40% (4/10) of HHV-8 seropositive heart transplant recipients developed reactivation, and 2 of them (50%) had fatal KS. Serologic screening and molecular surveillance of D+/R- patient groups facilitate early recognition and effective therapy of KICS.
卡波西肉瘤相关疱疹病毒/人类疱疹病毒8型（HHV-8）在实体器官移植受者中引发的肿瘤性和非肿瘤性疾病可能危及生命。我们评估了2011年至2023年连续的实体器官移植（SOT）患者中供者（D）和受者（R）的HHV-8感染血清流行率、HHV-8传播/再激活的发生率，以及HHV-8相关疾病的临床特征、管理和结局，包括卡波西肉瘤相关疱疹病毒相关炎性细胞因子综合征（KICS）。1349名供者中HHV-8血清流行率为3.3%，1856名接受筛查的受者中为8.4%（P <.0001）。在D+/R-组（n = 49）中，13名患者发生了HHV-8相关疾病：7名肝移植受者患有KICS，1名肺移植受者患有卡波西肉瘤并随后发生KICS。4名接受利妥昔单抗治疗的KICS患者存活，而3名未接受利妥昔单抗治疗的患者死亡。在D-/R-组中，5名（0.3%）非供者源性原发性HHV-8感染患者中，3名肝移植受者发生了KICS。在R+患者（n = 155）中，3名发生了卡波西肉瘤。在我们的队列中，25/944（2.6%）肝移植受者发生原发性HHV-8感染，其中10名（40%）发生了KICS；HHV-8血清阳性的心脏移植受者中有40%（4/10）发生再激活，其中2名（50%）患有致命性卡波西肉瘤。对D+/R-患者组进行血清学筛查和分子监测有助于早期识别和有效治疗KICS。
