[HHV8, Kaposi's disease and organ transplantation: should we screen ?]

The incidence of Kaposi's sarcoma (KS) related to Kaposi's sarcoma associated herpesvirus (KSHV/HHV-8) after organ transplantation is 500-1 000 times greater than in the general population and its occurrence is associated with immunosuppressive therapy. The reported incidence of post-transplant KS ranges from 0.5 % to 5 %, depending on the patient's country of origin and the type of organ received, mainly following renal transplantation. Post-transplant KS is caused by two possible mechanisms: KSHV reactivation in patients who were infected before the graft and KSHV contamination from infected organs donor to the recipient. KSHV reactivation appears to play a greater role on the risk of KS than incident infections. However, some studies, with findings based not only on serological data but also on molecular tracing of the viral infection, have shown that organ-related transmission of KSHV could be more common than previously thought and associated in some cases with severe KSHV related disease. Precise estimates of KSHV seroprevalence in the organ donor and recipient populations in different countries are lacking. However, studies have reported seroprevalences among donors and recipients that are similar to those among the general population of the country considered. Many studies have suggested the potential interest of screening of KSHV antibodies among organ donors and recipients. However, to date the results of these studies have argued in favor of KSHV screening, even in low KSHV infection prevalence countries, not to exclude the graft but to have the KSHV status information in order to have the opportunity to monitor, clinically and biologically, patients at risk to KSHVrelated disease development. The detection of KSHV antibodies could be done the days after the transplantation and the results transmitted to the physicians retrospectively. In conclusion, the question of screening donors and recipients for KSHV, even in low KSHV infection prevalence countries, is still debated and prospective studies are needed to evaluate the benefit of pre and posttransplantation strategies.