Kaposi’s sarcoma after liver transplantation
- First Online:
- 142 Downloads
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.
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.
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.
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.
KeywordsLiver transplantation Kaposi’s sarcoma HHV8 coinfection
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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