Kaposi’s sarcoma after liver transplantation

  • Fabrizio Di Benedetto
  • Stefano Di Sandro
  • Nicola De Ruvo
  • Massimiliano Berretta
  • Michele Masetti
  • Roberto Montalti
  • Roberto Ballarin
  • Stefania Cocchi
  • Leonardo Potenza
  • Mario Luppi
  • Giorgio E. Gerunda
Original Paper

Abstract

Introduction

Kaposi’s Sarcoma (KS) is a malignant neoplasm arising from endothelial cells. HHV8-infection represents a key pathogenic determinant for the development of KS. There are no standard criteria to treat KS in immunosuppressed-individuals. Six cases (2.1%) of KS occurred in our Center among 285-recipients who underwent liver transplantation (LT) between October 2000 and November 2006.

Methods

Patients were four males and two females. Mean age was 57 years (range 44–65). Indication for LT was ESLD associated/non-associated with hepatocellular carcinoma (HCC). The immunosuppressive regimen consisted of cyclosporine/tacrolimus associated with steroids or daclizumab. HHV8-detection was performed by the serological method before LT, and by polymerase chain reaction (PCR)-analysis after KS.

Results

One patient had HCV-related cirrhosis and coinfection from HIV, three had HBV-related cirrhosis, two of these with coexistent HCC. The last two patients had alcoholic-cirrhosis, one with coexistent HCC. Mean time from transplantation to KS was 6.2 months (range 3.8–8.8). Three patients were treated with doxorubicin and three with switch from calcineurin-inhibitors to sirolimus. Three patients expired after 11.5, 8.8, and 7.4 months from KS diagnosis.

Discussion

KS should be treated by a multidisciplinary approach to obtain an early diagnosis and best management. Effective treatment with immunosuppression reduction or switch to sirolimus is mandatory and can induce complete regression.

Keywords

Liver transplantation Kaposi’s sarcoma HHV8 coinfection 

References

  1. Andreoni M, Goletti D, Pezzotti P, Pozzetto A, Monini P, Sarmati L, Farchi F, Tisone G, Piazza A, Pisani F, Angelico M, Leone P, Citterio F, Ensoli B, Rezza G (2001) Prevalence, incidence and correlates of HHV-8/KSHV infection and Kaposi’s sarcoma in renal and liver transplant recipients. J Infect 43(3):195–199PubMedCrossRefGoogle Scholar
  2. Antman K, Chang Y (2000) Kaposi’s sarcoma. N Engl J Med 342(14):1027–1038 (review)PubMedCrossRefGoogle Scholar
  3. Aseni P, Vertemati M, Minola E, Arcieri K, Bonacina E, Camozzi M, Osio C, Forti D (2001) Kaposi’s sarcoma in liver transplant recipients: morphological and clinical description. Liver Transpl 7(9):816–823PubMedCrossRefGoogle Scholar
  4. Boeckle E, Boesmueller C, Wiesmayr S, Mark W, Rieger M, Tabarelli D, Graziadei I, Hoefer D, Antretter H, Stelzmueller I, Krugmann J, Zangerle R, Huemer H, Poelzl G, Margreiter R, Bonatti H (2005) Kaposi sarcoma in solid organ transplant recipients: a single center report. Transplant Proc 37(4):1905–1909PubMedCrossRefGoogle Scholar
  5. Brenner B, Rakowsky E, Katz A, Gutman H, Sulkes A, Schacter J, Fenig E (1999) Tailoring treatment for classical Kaposi’s sarcoma: comprehensive clinical guidelines. Int J Oncol 14(6):1097–1102PubMedGoogle Scholar
  6. Calabro ML, Sheldon J, Favero A, Simpson GR, Fiore JR, Gomes E, Angarano G, Chieco-Bianchi L, Schulz TF (1998) Seroprevalence of Kaposi’s sarcoma-associated herpesvirus/human herpesvirus 8 in several regions of Italy. J Hum Virol 1(3):207–213PubMedGoogle Scholar
  7. Chan JKC (1997) Vascular tumors with a prominent spindle cell component. Curr Diagn Pathol 4:76–90CrossRefGoogle Scholar
  8. Franceschi S, Rezza G, Serraino D, Cozzi Lepri A, Geddes M, Cote T (1995) Risk for Kaposi’s sarcoma among Italian women with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol 9(3):313–314PubMedCrossRefGoogle Scholar
  9. Friborg J Jr, Kong W, Hottiger MO, Nabel GJ (1999) p53 inhibition by the LANA protein of KSHV protects against cell death. Nature 402(6764):889–894PubMedGoogle Scholar
  10. Gao SJ, Kingsley L, Li M, Zheng W, Parravicini C, Ziegler J, Newton R, Rinaldo CR, Saah A, Phair J, Detels R, Chang Y, Moore PS (1996) KSHV antibodies among Americans, Italians and Ugandans with and without Kaposi’s sarcoma. Nat Med 2(8):925–928PubMedCrossRefGoogle Scholar
  11. Guba M, von Breitenbuch P, Steinbauer M, Koehl G, Flegel S, Hornung M, Bruns CJ, Zuelke C, Farkas S, Anthuber M, Jauch KW, Geissler EK (2002) Rapamycin inhibits primary and metastatic tumor growth by antiangiogenesis: involvement of vascular endothelial growth factor. Nat Med 8(2):128–135PubMedCrossRefGoogle Scholar
  12. Gutierrez-Dalmau A, Campistol JM (2005) Kaposi’s sarcoma after renal transplantation. N Engl J Med 353(8):846–847 (author reply 846–847)Google Scholar
  13. Jayachandra S, Low KG, Thlick AE, Yu J, Ling PD, Chang Y, Moore PS (1999) Three unrelated viral transforming proteins (vIRF, EBNA2, and E1A) induce the MYC oncogene through the interferon-responsive PRF element by using different transcription coadaptors. Proc Natl Acad Sci USA 96(20):11566–11571PubMedCrossRefGoogle Scholar
  14. Klein E, Schwartz RA, Laor Y, Milgrom H, Burgess GH, Holtermann OA (1980) Treatment of Kaposi’s sarcoma with vinblastine. Cancer 45(3):427–431PubMedCrossRefGoogle Scholar
  15. Lebbe C, Euvrard S, Barrou B, Pouteil-Noble C, Garnier JL, Glotz D, Legendre C, Frances C (2006) Sirolimus conversion for patients with posttransplant Kaposi’s sarcoma. Am J Transplant 6(9):2164–2168 (Epub 2006 Jun 19)PubMedCrossRefGoogle Scholar
  16. Lesnoni La Parola I, Masini C, Nanni G, Diociaiuti A, Panocchia N, Cerimele D (1997) Kaposi’s sarcoma in renal-transplant recipients: experience at the Catholic University in Rome, 1988–1996. Dermatology 194(3):229–233PubMedCrossRefGoogle Scholar
  17. London NJ, Farmery SM, Will EJ, Davison AM, Lodge JP (1995) Risk of neoplasia in renal transplant patients. Lancet 12: 346(8972):403–446 (Erratum in Lancet 346(8976):714)Google Scholar
  18. Margolius L, Stein M, Spencer D, Bezwoda WR (1994) Kaposi’s sarcoma in renal transplant recipients. Experience at Johannesburg Hospital, 1966–1989. S Afr Med J 84(1):16–17PubMedGoogle Scholar
  19. Martin JN, Ganem DE, Osmond DH, Page-Shafer KA, Macrae D, Kedes DH (1998) Sexual transmission and the natural history of human herpesvirus 8 infection. N Engl J Med 338(14):948–954PubMedCrossRefGoogle Scholar
  20. Moore PS, Gao SJ, Dominguez G, Cesarman E, Lungu O, Knowles DM, Garber R, Pellett PE, McGeoch DJ, Chang Y (1996) Primary characterization of a herpesvirus agent associated with Kaposi’s sarcoma. J Virol 70(1):549–558. Erratum in J Virol 70(12):9083Google Scholar
  21. Nickoloff BJ, Griffiths CE (1989) The spindle-shaped cells in cutaneous Kaposi’s sarcoma. Histologic simulators include factor XIIIa dermal dendrocytes. Am J Pathol 135(5):793–800PubMedGoogle Scholar
  22. Penn I (1990) Cancers complicating organ transplantation. N Engl J Med 323(25):1767–1769PubMedCrossRefGoogle Scholar
  23. Penn I (1995) Sarcomas in organ allograft recipients. Transplantation 60(12):1485–91 (review)PubMedGoogle Scholar
  24. Reynolds WA, Winkelmann RK, Soule EH (1965) Kaposi’s sarcoma: a clinicopathologic study with particular reference to its relationship to the reticuloendothelial system. Medicine (Baltimore) 44(5):419–443 (review)CrossRefGoogle Scholar
  25. Shepherd FA, Maher E, Cardella C, Cole E, Greig P, Wade JA, Levy G (1997) Treatment of Kaposi’s sarcoma after solid organ transplantation. J Clin Oncol 15(6):2371–2377PubMedGoogle Scholar
  26. Shiffman ML, Saab S, Feng S, Abecassis MI, Tzakis AG, Goodrich NP, Schaubel DE (2006) Liver and intestine transplantation in the United States, 1995–2004. Am J Transplant 6(5 Pt 2):1170–1187PubMedCrossRefGoogle Scholar
  27. Stallone G, Schena A, Infante B, Di Paolo S, Loverre A, Maggio G, Ranieri E, Gesualdo L, Schena FP, Grandaliano G (2005) Sirolimus for Kaposi’s sarcoma in renal-transplant recipients. N Engl J Med 352(13):1317–1323PubMedCrossRefGoogle Scholar
  28. Whitby D, Howard MR, Tenant-Flowers M, Brink NS, Copas A, Bishoff C, Hatzioannou T, Suggett FEA, Aldam DM, Denton AS, Miller RF, Weller IVD, Weiss RA, Tedder RS, Schultz TF (1995) Detection of Kaposi’s sarcoma associated herpesvirus in peripheral blood of HIV-infected individuals and progression to Kaposi’s sarcoma. Lancet 346:799–802PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Fabrizio Di Benedetto
    • 1
  • Stefano Di Sandro
    • 1
  • Nicola De Ruvo
    • 1
  • Massimiliano Berretta
    • 2
  • Michele Masetti
    • 1
  • Roberto Montalti
    • 1
  • Roberto Ballarin
    • 1
  • Stefania Cocchi
    • 3
  • Leonardo Potenza
    • 4
  • Mario Luppi
    • 4
  • Giorgio E. Gerunda
    • 1
  1. 1.Liver and Multivisceral Transplant CenterUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.Division of Medical Oncology ANational Cancer Institute, Centro di Riferimento OncologicoAvianoItaly
  3. 3.Department of Internal Medicine and Medical Specialties Infectious Diseases ClinicUniversity of Modena and Reggio EmiliaModenaItaly
  4. 4.Section of Haematology, Department of Oncology and HaematologyUniversity of Modena and Reggio EmiliaModenaItaly

Personalised recommendations