 |
|
Clinical Features and Contribution of Virological Findings to the Management of Kaposi Sarcoma in Organ-Allograft Recipients
Stéphane Barete, MD;
Vincent Calvez, MD, PhD;
Catherine Mouquet, MD;
Benoît Barrou, MD;
Henri Kreis, MD;
Jacques Dantal, MD;
Richard Dorent, MD;
François Durand, MD;
Yves Dimitrov, MD;
Nicolas Dupin, MD;
Anne-Geneviève Marcelin, PharmD;
Jean-Charles Piette, MD;
Marc Olivier Bitker, MD;
Camille Francès, MD
Arch Dermatol. 2000;136:1452-1458.
Objectives 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.
Design, Setting, and Patients 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 330233 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.
Intervention 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.
Main Outcome Measures 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.
From the Departments of Internal Medicine (Drs Barete, Piette, and Francès), Renal Transplantation (Drs Mouquet, Barrou, and Bitker), Virology (Drs Barete, Calvez, Dupin, and Marcelin), and Heart Transplantation (Dr Dorent), Pitié-Salpêtrière Hospital and the Department of Renal Transplantation, Necker Hospital (Dr Kreis), Paris; the Department of Renal Transplantation (Dr Dantal), Hôtel-Dieu Hospital, Nantes; the Department of Liver Transplantation, Beaujon Hospital, Clichy (Dr Durand); the Unit of Renal Transplantation, Civil Hospital, Strasbourg (Dr Dimitrov), France.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Evidence for a Multiclonal Origin of Multicentric Advanced Lesions of Kaposi Sarcoma
Duprez et al.
JNCI J Natl Cancer Inst 2007;99:1086-1094.
ABSTRACT
| FULL TEXT
Skin Cancers after Organ Transplantation
Euvrard et al.
NEJM 2003;348:1681-1691.
FULL TEXT
Successful treatment of post-transplant Kaposi's sarcoma by reduction of immunosuppression
Duman et al.
Nephrol Dial Transplant 2002;17:892-896.
ABSTRACT
| FULL TEXT
|
