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Adverse Occurrence type:
Donor seropositive/Recipient seronegative pairs followed up for two years post transplant , with 28 % seroconversion rate.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
French prospective, multicenter study to assess the risk of HHV8 transmission resulting from organ transplantation, and related morbidity in liver, heart and kidney transplant recipients. Donor and recipient serologies were screened for 1 year using HHV8 indirect immunofluorescence latent assay (latent IFA) and indirect immunofluorescent lytic assay (lytic IFA). Recipients negative for latent IFA with a donor positive for at least one test were sequentially monitored for HHV8 antibodies and DNA over a period of 2 years. Among 2354 donors, HHV8 seroprevalence was 9.9% (lytic IFA) and 4.4% (latent IFA). A total of 454 organ recipients were followed up, with seroconversion rates of 28%. Detectable viremia was rare (4 liver recipients) and 3 patients (2 liver, 1 kidney) developed KS. This study was performed due to the experience this French group had had with high HHV8-related morbidity in 6 out of 12 heart transplant recipients and in 2 out of 6 liver transplant recipients, including five cases of hemophagocytic syndrome with either polyclonal lymphoproliferation or KS, three of which, fatal. The authors conclude that although the occurrence of symptomatic donor-derived infection in SOT recipients is low, morbidity may be high.
Demonstration of imputability or root cause:
The study was designed to identify D+/R- serological mismatches to allow follow monitoring of recipients for evidence of de novo HHV8 infection and associated morbidity. Individual cases were not detailed in terms of proof of imputability but the figures generated were informative. Serology is an important tool and pre-transplant status for D/R is required to establish status.
Suggest new keywords:
HHV8, seroconversion, IFA, lytic antibodies; latent antibodies; HHV8 DNA; viremia; hemophagocytic syndrome; polyclonal lymphoproliferation; KS, Kaposi sarcoma
Human herpesvirus 8 (HHV8) transmission and related morbidity in organ recipients. Lebbe C et al. Am J Transplant. 2013 Jan;13(1):207-13
Expert comments for publication:
HHV8 is not an ubiquitous infection as other herpes viruses; patterns of distribution of infection, populations at risk, natural history, local epidemiology, disease presentation, early diagnosis and possible modes of intervention are some of the aspects that one needs to be familiar with in order to appropriately consider strategies to mitigate recipient harm. Considering donor-derived infection in the right context and acting early may also be helpful HHV8. Other records in this library contain description of clinical presentation and course of infection in transplant acquired HHV8 infection.