- Infection with Kaposi sarcoma-associated herpesvirus (KSHV) is the cause of Kaposi sarcoma, a type of cancer where lesions grow on the skin and other parts of the body.
- This CDC report detailed 46 cases of suspected donor-derived KSHV-related complications among 153 transplant recipients from 2021-2025, roughly five times the number of cases reported from 2016-2020.
- Of the 74 transplant recipients identified as having a KSHV infection, 61% developed Kaposi sarcoma.
Cases of suspected Kaposi sarcoma-associated herpesvirus (KSHV) infections in U.S. organ transplant recipients jumped in the last 5 years, highlighting the need for new screening tools and sharper clinical scrutiny in transplant patients, according to a CDC report.
There were 46 reports of suspected organ donor-derived KSHV-related complications in transplant recipients during January 2021 through September 2025, compared with nine such reports during 2016-2020 and two from 2010-2015, reported researchers led by Ian Kracalik, PhD, of the CDC in Atlanta.
Nearly half of the 153 transplant recipients during 2021-2025 (from 46 deceased donors) developed a posttransplant KSHV infection. Of those 74 individuals, 45 (61%) developed Kaposi sarcoma and 25 died, though KSHV's role in those deaths is under investigation, the study in Morbidity and Mortality Weekly Report indicated.
KSHV infection is the cause of Kaposi sarcoma, a type of cancer that causes lesions to form on the skin, lymph nodes, throat, and other areas of the body. Also known as human herpesvirus 8, the infections have as well been linked with lymphoproliferative disorders, such as multicentric Castleman disease, and KSHV inflammatory cytokine syndrome (KICS).
Among the patients who developed Kaposi sarcoma in the current CDC report, 10 also developed a lymphoproliferative disorder and six developed KICS.
Testing for KSHV, either for donors or recipients, is not routinely performed, according to the researchers.
"Clinicians caring for solid organ transplant recipients should maintain a high index of suspicion for KSHV and related complications, including KICS, symptoms of which might be similar to those of culture-negative sepsis," Kracalik and colleagues wrote. "Strategies are needed to increase testing capacity to enable routine organ donor screening and could help mitigate KSHV-related complications among transplant recipients."
The reported rise in KSHV-complicated transplants is unexplained.
In the U.S., KSHV transmission traditionally is linked with HIV and men who have sex with men (MSM), but 96% of the donors and 98% of the recipients in the study were HIV-negative, and relatively few were MSM (33% and 1%, respectively).
One of the causative culprits may lurk within the nation's opioid epidemic. Nonmedical injection and inhalation drug use is an increasingly recognized KSHV transmission risk factor. In 2010, only 4% of deceased U.S. organ donors died because of acute drug intoxication. By 2023, that share had risen to 17%, according to the study authors.
Among the 46 deceased donors, 67% had a history of nonmedical inhalation or injection drug use.
"A history of substance abuse in organ donors might contribute to increased risk for KSHV transmission to recipients, although this association might be confounded by undisclosed sexual behaviors," wrote Kracalik and colleagues.
It's hard to know exactly what's behind the rise in cases, study co-author Christine Durand, MD, of Johns Hopkins University in Baltimore, told MedPage Today. "It could reflect an increase in infection risk among our deceased donors in the United States, or it could reflect improved recognition and diagnosis by clinicians caring for transplant recipients. Or both."
A key challenge is the lack of an FDA-approved serology assay to screen for KSHV in donors and recipients. The existing assay for clinical testing is operator-dependent and not easy to scale, Durand noted. A molecular PCR-based assay could theoretically monitor transplant recipients for infection, she added, "but we don't know who to monitor, how often to monitor, nor what to do with a positive test."
Despite the challenges, Durand recommended that clinicians keep the KSHV diagnosis in mind, particularly in lung and liver recipients who present with signs and symptoms that might be explained by the virus.
In the present study, the CDC team investigated reports of suspected KSHV infection sent from transplant centers to the Organ Procurement Transplantation Network from January 2021 to September 2025. A total of 153 transplant recipients received 185 solid organs implicated in the KSHV transmission.
The deceased donors had a median age of 38.5 years, and two-thirds were men. Of the 29 donors with completed testing after organ procurement, 86% had a positive molecular or serologic KSHV test result.
The 153 transplant recipients had a median age of 58.5 years, and half were men. Among the 74 recipients with a positive KSHV test result, an infected lung was most commonly implicated (86%), followed by an infected liver (57%), heart (30%), or kidney (22%). Median time from transplant to the first clinical manifestation was 208 days.
Study limitations included the potential for underreporting of cases and underestimation of organ recipient infections. In addition, some KSHV infections may have been reactivated recipient infections or new infections after a transplant.
Reports of donor-derived KSHV infection remain relatively uncommon, the researchers noted, with such cases happening among fewer than 0.5% of all those who receive transplants. Despite donors' risk factors for infectious diseases such as KSHV, their organs can still be used safely, the researchers asserted.
Disclosures
Kracalik had no disclosures. Co-authors reported relationships with Kamada, Merck, Scynexis, and Takeda.
Durand reported payment from Gilead Sciences for service on a grant review committee.
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