Multicenter Prospective Study for Laboratory Diagnosis of HHV8 Infection in Solid Organ Donors and Transplant Recipients and Evaluation of the Clinical Impact After Transplantation.
We performed serological and molecular pretransplant screening in solid organ transplant (SOT) donors and recipients in north central Italy and a surveillance program for human herpesvirus 8 (HHV8) infection after transplant, aiming to establish an optimal management of HHV8 infection in SOT recipients.



For pretransplant HHV8 screening in both donors and recipients, 6 serological (4 indirect immunofluorescent assays [IFA] and 2 enzyme-linked immunosorbent assays-both HHV8 lytic and latent antigen based) and 2 molecular assays were used. A reference standard to identify HHV8-positive patients was defined by at least 2 positive assays. All transplant patients at risk to develop HHV8-related disease underwent virological posttransplant monitoring by quantitative real-time polymerase chain reaction (PCR) assay.



Human herpesvirus 8 seroprevalence was 4% (10/249) in donors and 18% (93/517) in organ recipients. The best performance was obtained by 2 lytic antigen-based IFAs that showed almost perfect agreement to the reference standard (0.943 and 0.931 Cohen kappa). Human herpesvirus 8-DNA was detected in 6.8% and 2.9% of HHV8-seropositive donor samples by in-house nested PCR and quantitative real-time PCR assays, respectively. After transplant, 3 (25%) of 12 HHV8-mismatch patients (seropositive donor/seronegative recipient) developed a primary infection, one of whom developed a lethal nonmalignant illness. Two of 93 HHV8-seropositive recipients (2.1%) had viral replication in posttransplant period, one of whom developed Kaposi sarcoma.



Serological assays, specifically lytic IFAs, were the best methodological approach to identify HHV8-infected SOT donors and recipients. A very low incidence (1.9%) of posttransplant HHV8-related disease was observed.
1 Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola-Malpighi University Hospital, Bologna, Italy. 2 Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, University of Modena and Reggio Emilia, Modena, Italy. 3 Italian National Transplant Centre-Italian National Institute of Health, Rome, Italy. 4 Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, University of Modena and Reggio Emilia, Modena, Italy. 5 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy. 6 UOS Trapianti rene pancreas, UO Nefrologia Azienda Ospedaliero-Universitaria di Parma. 7 Department of General Surgery and Transplantation, St. Orsola-Malpighi University Hospital, Bologna, Italy. 8 Heart and Lung Transplant Program, St. Orsola-Malpighi University Hospital, Bologna, Italy. 9 Department of Nephrology and Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. 10 Department of Biomedical and Neuromotor Sciences, Unit of Hygiene and Biostatistics, University of Bologna, Bologna, Italy. 11 Emilia Romagna Transplant Reference Centre, St. Orsola-Malpighi University Hospital, Bologna, Italy. 12 Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
Angela
A
Chiereghin
Patrizia
P
Barozzi
Evangelia
E
Petrisli
Giulia
G
Piccirilli
Liliana
L
Gabrielli
Giovanni
G
Riva
Leonardo
L
Potenza
Gianni
G
Cappelli
Nicola
N
De Ruvo
Irene
I
Libri
Umberto
U
Maggiore
Maria Cristina
MC
Morelli
Luciano
L
Potena
Paola
P
Todeschini
Dino
D
Gibertoni
Manuel
M
Labanti
Gabriela
G
Sangiorgi
Gaetano
G
La Manna
Antonio Daniele
AD
Pinna
Mario
M
Luppi
Tiziana
T
Lazzarotto
D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis*; D005260:Female; D006566:Herpesviridae Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D019288:Herpesvirus 8, Human / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011446:Prospective Studies; D014019:Tissue Donors; D066027:Transplant Recipients; D055815:Young Adult
D000914:Antibodies, Viral