KSHV after an organ transplant: should we screen?

Area of Science:

• Transplantation Immunology
• Infectious Diseases
• Oncology

Background:

• Posttransplant Kaposi sarcoma (KS) incidence is 500-1000 times higher than in the general population, linked to immunosuppression.
• Incidence ranges from 0.5% to 5%, primarily after renal transplantation, influenced by origin and organ type.

Purpose of the Study:

• To review the mechanisms of posttransplant Kaposi sarcoma (KS) development.
• To evaluate the role of Kaposi sarcoma-associated herpesvirus (KSHV/HHV-8) in posttransplant KS.
• To discuss the implications of KSHV screening in organ donors and recipients.

Main Methods:

• Literature review and synthesis of existing studies on posttransplant KS and KSHV.
• Analysis of KSHV transmission routes: reactivation versus donor-to-recipient transmission.
• Evaluation of serological and molecular data regarding KSHV prevalence and screening utility.

Main Results:

• Posttransplant KS is driven by KSHV reactivation or donor-derived infection, with reactivation often considered dominant.
• Emerging evidence suggests organ-related KSHV transmission may be more frequent than previously assumed.
• KSHV seroprevalence in donors and recipients often mirrors general population rates; screening utility is debated.

Conclusions:

• KSHV screening in organ donors and recipients, even in low-prevalence areas, could inform clinical monitoring for KSHV-related diseases.
• The decision to screen remains debated, necessitating prospective studies to assess pre- and post-transplantation strategies.
• Further research is required to definitively establish the benefits of KSHV screening protocols in transplantation.