TRANSMISSION OF HUMAN HERPESVIRUS 8 THROUGH THE GRAFT.

Abstract

O172 Aims: The aim of this study was to appreciate the frequency of human herpesvirus 8 (HHV-8) transmission through the graft and its consequences, that are still poorly known. Methods: A prospective national study was conducted from October 2000 to December 2003. Antibodies to HHV-8 latent nuclear antigen were detected by indirect immunofluorescence in serum samples collected just before transplantation from french donors and from recipients of organs from positive donors. Recipients who were negative for HHV-8 and who received an organ from a positive donor were included in the study. They were followed every 3 months with dermatological examination and collection of blood samples for HHV-8 viremia in peripheral blood mononuclear cells (quantitative real time polymerase chain reaction assay), detection of antibodies to latent nuclear antigen (immunofluorescent assay), and to lytic orf K8.1 antigen (enzyme-linked immunosorbent assay). The prevalence of donors who were positive for HHV-8 was 1.08 (40/3694). Fifty-eight kidney recipients, 15 liver recipients and 8 heart or heart and lung recipients were initially included. Eleven kidney recipients, 2 liver recipients and 2 heart recipients were further excluded because they were not followed for at least one year (early death: 6, graft lost: 4, foreigners: 5). Results: Two of the 47 kidney recipients (4.2%) had HHV-8 primary infection with positive viremia. The first one presented with febrile bicytopenia and hemophagocytosis with high viremia levels. All clinical and biological manifestations disappeared after treatment with rituximab; all the viremia were subsequently negative. The second had Kaposi’s sarcoma (KS) which decreased after progressively tapering immunosuppressive therapy. Five of the 13 liver recipients (38.5%) had positive viremia. Two presented fatal diffuse KS and HHV-8 positive lymphoproliferation; they were not treated for their HHV-8 primary infection. Two others had fever and liver biological abnormalities with high levels of viremia. One of them developed pancytopenia and hemophagocytosis; the other had cutaneous and visceral KS; they were treated successfully with rituximab and foscavir or ganciclovir. The last liver recipient had positive viremia without clinical manifestations. Two of the 6 heart recipients (33.3%) had positive viremia. The first one developed cutaneous and visceral KS with medium levels of viremia. KS improved with decrease of immunosuppressive therapy and liposomal anthracyclin; the second developed fever, pancytopenia, hemophagocytosis, pleural effusion and diffuse KS with high levels of viremia. She was transiently improved with rituximab and died a few months later from multiple visceral failing. The presence of antibodies to HHV-8 latent nuclear antigen was not an early marker for detection of HHV-8 primary infection. Conclusions: Transmission of HHV-8 infection through the graft appeared less frequent in kidney recipients than in liver or heart recipients (p<0.005). HHV-8 primary infections transmitted from the donor often present as a febrile disease with cytopenia, hemophagocytosis, with or without KS. Clinical and biological manifestations may resolve with an early treatment with rituximab and/or antiviral drugs.