HHV-8 Infection in Solid-Organ Transplant-Pathogenesis, Epidemiology, Clinical Manifestations and Management

Area of Science:

• Virology
• Immunology
• Transplantation Medicine

Background:

• Human herpesvirus-8 (HHV-8), also known as KSHV, is an oncogenic virus.
• HHV-8 infection is uncommon but can lead to severe diseases in solid-organ transplant recipients, including Kaposi sarcoma (KS), multicentric Castleman disease (MCD), primary effusion lymphoma (PEL), and KSHV inflammatory cytokine syndrome (KICS).
• These HHV-8-associated diseases can cause significant morbidity, graft loss, and mortality.

Purpose of the Study:

• To review the current understanding of HHV-8 infection in solid-organ transplant recipients.
• To focus on epidemiology, transmission, pathogenesis, clinical manifestations, diagnostics, and management of major HHV-8 syndromes.
• To propose a risk-stratified screening algorithm and management framework for HHV-8 PCR positivity.

Main Methods:

• Literature review summarizing current knowledge on HHV-8 in solid-organ transplant recipients.
• Analysis of epidemiology, transmission, pathogenesis, clinical presentations, diagnostic methods, and management strategies.
• Development of a proposed screening algorithm and management framework.

Main Results:

• HHV-8-associated diseases present a wide clinical spectrum, often with delayed recognition due to nonspecific symptoms.
• Regional variations in HHV-8 seroprevalence and immunosuppressive strategies complicate management.
• There is a lack of standardized screening and monitoring protocols.

Conclusions:

• Effective management of HHV-8 in transplant recipients requires addressing knowledge gaps and therapeutic challenges.
• Standardized surveillance and a proposed risk-stratified screening algorithm and management framework are crucial for improving outcomes.
• Further research is needed to refine prevention and treatment strategies for these rare but serious complications.