Cardiac Kaposi's sarcoma following heart transplantation.

Kaposi's sarcoma (KS) is a tumor seen with increased frequency in organ transplant recipients. We present a case of disseminated KS in a heart transplant recipient of Mediterranean origin in whom myocardial involvement was suspected on the basis of coronary angiographic and magnetic resonance imaging (MRI) findings. KS in the transplant population and cardiac KS are reviewed. Cathet. Cardiovasc. Intervent. 49:208-212, 2000.     

Angioimmunoblastic lymphadenopathy following Kaposi's sarcoma

The close relationship of Kaposi's sarcoma (KS) with other lymphoproliferative disorders is a poorly understood, but well documented, phenomenon. A case is presented of a 68-year-old woman with the classical form of cutaneous KS in whom disappearance of the lesions after treatment was shortly followed by the development of angioimmunoblastic lymphadenopathy, pursuing a fulminant course to death. Postmortem examination revealed diffuse involvement of the marrow, spleen, liver, and lymph nodes by the immunoblastic proliferation. The close association of these two conditions may represent more than a chance occurrence. The appearance of a constellation of nonspecific symptoms suggestive of a lymphoproliferative disorder in debilitated patients with KS should alert the physician to the possibility of the development of this rare complication.     

Kaposi's sarcoma: the most common tumor after renal transplantation in Saudi Arabia

Between September 1975 and November 1986, 263 renal transplant recipients at the King Faisal Specialist Hospital and Research Center were followed; 82 procedures were done by the authors using live related donors. Among the 263 patients, 14 cases of Kaposi's sarcoma were identified, an incidence of 5.3 percent compared with an incidence of 0.4 percent in renal transplant recipients from Western countries. In addition, two more patients had other types of tumors. Thus, Kaposi's sarcoma represents 87.5 percent of tumors in the King Faisal Hospital renal transplant population, in contrast to 3.7 percent in the Cincinnati Transplant Tumor Registry. The mean period between transplantation and diagnosis of Kaposi's sarcoma was 12.5 months (range, one to 37 months). Eleven patients were Saudis and three were other Arab nationals. Seven of the 11 Saudi patients were from the southwestern region of the country. Cytomegalovirus titers were not elevated in six of 10 patients. Results of tests for human immunodeficiency virus were negative in seven of eight patients. HLA-A2 antigen frequency was significantly increased in the King Faisal Hospital renal transplant patients with Kaposi's sarcoma as compared with a control population (83.3 percent versus 43.6 percent, p value = 0.006 [P = 0.06 with Bonferroni adjustment]), and increased, though nonsignificantly, compared with the live related kidney transplant recipients without Kaposi's sarcoma (83.3 percent versus 49.4 percent, p value = 0.058 [P = 0.58 with Bonferroni adjustment]), suggesting a genetic predisposition to Kaposi's sarcoma in these patients.     

Post renal transplantation human herpesvirus 8-associated lymphoproliferative disorder and Kaposi's sarcoma

Post-transplantation lymphoproliferative disorders (PTLDs) and Kaposi's sarcoma (KS) are immunosuppression-related tumours developing in solid organ transplant patients. Although the Epstein-Barr virus (EBV) is detected in the majority of the PTLDs during the first year after transplantation, the proportion of EBV-negative PTLDs has increased in recent years. We report a case of a 17-year-old man who developed severe immune haemolytic anaemia, KS and human herpesvirus 8 (HHV-8)-associated, polymorphic-type PTLD 9 months after allogeneic renal transplantation from his HHV-8-seropositive father. It is suggested that: (i) HHV-8 may be associated with EBV-negative, polymorphous-type PTLD occurring less than 1 year after transplantation, and (ii) PTLD may be listed among other tumours, including KS, Castleman's disease and primary effusion lymphoma (PEL), that are related to HHV-8 infection.     

Kaposi's syndrome following transplantation

Kaposi's sarcoma has particularly been described after renal transplantation. More recently, a number of cases have been reported after hepatic or cardiac transplantation. The fostering factors are the same as for the other Kaposi's sarcomas, while the HIV1 or HIV2 serology is always negative. Renal transplantation may increase the natural risk of Kaposi's sarcoma by a factor of 4 to 500. The immunodepressive treatment must be reduced in case of purely cutaneous Kaposi and interrupted in case of visceral involvement. Death generally occurs as a consequence of infections. Kaposi's sarcoma after heart transplantation has a poorer prognosis, with fatal evolution in the four cases observed out of the 967 cardiac transplantations performed in the Ile-de-France region from 1968 to 1990; the cause of death most often is graft rejection or an infection.     

Kaposi's sarcoma following allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia

Unlike solid organ transplantation, Kaposi's sarcoma (KS) occurs rarely following hematopoietic stem cell transplantation (HSCT). In fact, only 5 cases of KS have been reported after allogeneic or autologous HSCT. The usual treatment combines a substantial decrease in, or elimination of, immunosuppressive therapy along with local measures such as surgical excision, cryotherapy or radiation therapy. A 46-year-old woman with chronic myelogenous leukemia who had received an allogeneic HSCT previously from an HLA-identical sibling, presented on day +814 with human herpes virus-8-associated KS involving her left lower extremity. She had been on continuous immunosuppressive therapy since her transplant because of chronic graft-versus-host disease. The intensity of immunosuppressive therapy was decreased once a diagnosis of KS had been established. However, the nodular lesions continued to progress in size and number. Therefore, a course of irradiation was administered to sites of bulk disease on her legs. Furthermore, thalidomide was initiated along with a topical retinoid, alitretinoin 0.1% gel applied twice daily to the nonirradiated lesions. This approach yielded a partial response in both irradiated and nonirradiated lesions over the course of the following 7 months. Both thalidomide and alitretinoin 0.1% gel appear to be beneficial in HSCT-associated KS and exhibit tolerable side effects.     

Kaposi's sarcoma in recipients of renal transplants.

The purpose of this study was threefold; to ascertain if immunosuppression may be a factor in the causation of Kaposi's sarcoma, to find out if there is a correlation between abnormalities in in vitro studies of cellular immune function and the extent of the disease, and to analyze the literature on Kaposi's sarcoma arising in renal transplant recipients to determine a management policy for these patients.The charts of 44 patients with Kaposi's sarcoma seen in a 20 year period at The Princess Margaret Hospital were reviewed in a search for evidence of immunosuppression as a possible risk factor. Such evidence was found in seven patients. Four of these seven patients were renal transplant recipients, two had generalized lymphomas and were receiving chemotherapy whereas one had a glioblastoma multiforme and was receiving chemotherapy.Studies of cellular immunity using phytohemagglutinin, conconavalin A, pokeweed mitogen, the mixed leukocyte reaction and dinitrochlorobenzene skin testing, in eight patients with Kaposi's sarcoma, three of whom had previous renal transplants, indicate that a correlation exists between the degree of immunologic deficiency and the extent of the Kaposi's sarcoma.Our seven patients were all of Jewish or Mediterranean ancestry. The four cases of Kaposi's sarcoma arising in renal transplant recipients developed in a population of 100 renal transplant recipients of similar ethnic background (4 per cent). This incidence, when compared with our experience of 40 cases arising in 500,000 people of similar ancestry in the Toronto area, represents a 400 to 500 fold greater incidence in renal transplant recipients than in the control population. A literature review has yielded 12 additional cases of Kaposi's sarcoma developing in renal transplant recipients. On the basis of this review and our own experience we have proposed a management policy for these patients.It is proposed that the etiology of Kaposi's sarcoma is multifactorial and that a combination of immunosuppression and/or immunologic stimulation combined with a hereditary predisposition to the disease are responsible for the major increase in its incidence.     

Kaposi's sarcoma in a renal transplant patient receiving cyclosporine

A patient of Middle-Eastern descent developed Kaposi's sarcoma of the skin and lymph nodes after renal transplantation while receiving medical immunosuppression, including the use of cyclosporine. The clinical presentation of this patient resembled that of the HTLV-III-associated Kaposi's sarcoma. The tumors totally regressed seven weeks after cessation of immunotherapy. This case, along with other recently reported cases of Kaposi's sarcoma in postrenal transplant patients receiving cyclosporine, illustrates a rare complication of current immunosuppressive therapy.     

Association of disseminated nocardiosis and Kaposi's sarcoma after kidney transplantation

We report a 40-year-old kidney recipient who developed disseminated nocardiosis associated with cutaneous Kaposi's sarcoma. The withdrawal of immunosuppressive therapy and prolonged antibiotic therapy, including imipenem and trimethoprim-sulfamethoxazole, resulted in a favourable outcome of both disorders. Three years later, graft function remains stable with a complete regression of skin and pulmonary abnormalities. This case report illustrates the predisposing role of immunosuppressive treatment in the occurrence of infectious and neoplastic complications observed after solid-organ transplantation.     

Kaposi's sarcoma following immune suppressive therapy for Wegener's granulomatosis

The association between Kaposi's sarcoma and infection with human herpesvirus 8 is now well recognized. Immunologic impairment is associated with 2 forms of Kaposi's sarcoma, epidemic [associated with human immunodeficiency virus (HIV) infection] and iatrogenic (associated with immunosuppressive treatment); both forms have become more common during the last decade. We describe an HIV negative 54-year-old man who developed Kaposi's sarcoma 2 months after the beginning of immuno-suppressive therapy for Wegener's granulomatosis (WG). With tapering of medication, complete remission of Kaposi's sarcoma was achieved in one year. To our knowledge, this is the second reported case of iatrogenic Kaposi's sarcoma in a patient with WG.     

Kaposi's sarcoma of the bronchial tree in a renal transplant recipient

An unusual case of disseminated Kaposi's sarcoma with endobronchial lesions is presented; these localizations are quite uncommon in the course of the disease, particularly in kidney transplant recipients. Some of the multifactorial etiologies of Kaposi's sarcoma are present: immunosuppression, ethnic origin and CMV infection. We emphasize that the diagnosis of bronchial involvement can be made during fiberoptic bronchoscopy and confirmed by biopsy without excessive complications.     

Donor-derived human herpes virus 8-related Kaposi's sarcoma in renal allograft ureter

Abstract: We present a case of human herpes virus 8 (HHV8)-associated Kaposi sarcoma (KS) occurring in a renal allograft ureter from a male donor. The female patient presented with a rising creatinine due to ureteric obstruction, and subsequent histological examination of the excised tumor revealed a KS. The tumor tested positive for HHV8 antigen and, using in situ hybridization to identify X and Y chromosomes, we were able to demonstrate that the tumor was of male origin. In the absence of any other KS lesions, this suggested that the tumor arose due to reactivation of latent HHV8 in the donor tissue, permitted by the recipient's immunosuppression. The patient was managed by a gradual reduction in immunosuppression and there has been no subsequent recurrence of the tumor. KS in renal transplantation is discussed in detail including the possible utility of pre-transplant HHV8 screening.