Clinical features and contribution of virological findings to the management of Kaposi sarcoma in organ-allograft recipients.
OBJECTIVE
To describe the clinical features of Kaposi sarcoma (KS) in organ-allograft recipients and to determine the contribution of human herpesvirus 8 (HHV-8) investigations to the management of KS.


METHODS
We examined 20 organ-allograft recipients with KS at Pitié-Salpêtrière Hospital, Paris, France, between November 1, 1991, and May 31, 1999.


METHODS
We detected HHV-8 antibodies using an indirect immunofluorescence assay and the HHV-8 DNA genome using nonnested polymerase chain reaction with KS-associated herpesvirus 330(233) primers in peripheral blood mononuclear cells collected at transplantation and KS diagnosis. We detected the HHV-8 genome in involved and uninvolved tissue specimens and in 10 patients' serum samples collected 1 month before the first manifestation of KS. We determined the HHV-8 double-strand DNA sequence and subtypes of open reading frame 26.


METHODS
Management of KS consisted of progressively tapering immunosuppressive therapy regardless of KS dissemination. Associated infections were treated when possible. Chemotherapy was prescribed only when a functional disability persisted, and polychemotherapy was prescribed for life-threatening disease.


METHODS
Percentage of recipients with KS remission and stabilization, organ-graft survival, and death rates.


RESULTS
Remission of KS was obtained in 9 (45%) of the 20 patients independently of disease dissemination, with a mean follow-up of 35 months. The kidney graft survived in 12 (67%) of the 18 patients. Only 1 patient (5%) died of KS progression. All allograft recipients had anti-HHV-8 antibodies before transplantation. We detected HHV-8 DNA in all involved tissue samples but not in serum samples 1 month before KS onset. The most prevalent subtype was HHV-8 C (9 [53%] of 17 patients) and was not associated with extradermatological extension of KS compared with subtypes A and B'.


CONCLUSIONS
Virological investigations of HHV-8 contribute poorly to KS management. Prospective studies are needed to determine the role of HHV-8 virological investigations and to identify associated cofactors so as to prevent KS in organ-allograft recipients.
Barete
S
S
Service de Virologie CERVI, Groupe Hospitalier Pitié-Salpêtrière, 83, Boulevard de l'Hôpital 75651, Paris, Cedex 13, France. stephane.barete@psl.ap-hop-paris.fr
Calvez
V
V
Mouquet
C
C
Barrou
B
B
Kreis
H
H
Dantal
J
J
Dorent
R
R
Durand
F
F
Dimitrov
Y
Y
Dupin
N
N
Marcelin
A G
AG
Piette
J C
JC
Bitker
M O
MO
Francès
C
C
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D005455:Fluorescent Antibody Technique; D016027:Heart Transplantation; D019288:Herpesvirus 8, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D016133:Polymerase Chain Reaction; D012514:Sarcoma, Kaposi / Q000473:pathology / Q000628:therapy / Q000821:virology*
D004279:DNA, Viral; D007166:Immunosuppressive Agents