Outcome of kidney transplant recipients with previous human herpesvirus-8 infection

Background. The consequences of a prior human herpesvirus-8 (HHV-8) infecti on in kidney-transplant recipients are still partially unknown. The aim of this monocentric study was to determine the prevalence of HHV-8-seropositiv e patients at the time of transplantation and to identify the main clinical events of these HHV-8(+) recipients. Methods, From January 1, 1990 to December 31, 1996, antibodies to HHV-8 lat ent nuclear antigen were detected by indirect immunofluorescent method in s erum samples collected just before kidney transplantation from 400 consecut ive patients. Conventional double or triple immunosuppressive treatment was prescribed. For the group of HHV-8(+) recipients, data including death rat e, graft survival, and occurrence of Kaposi's sarcoma (KS) were retrospecti vely collected until December 31, 1998, Cofactors associated with KS were s tudied in univariate and multivariate analyses using a Cox model. Results, Thirty-two patients (8%) had antibodies to HHV-8 in their sera at the time of transplantation. Among these 32, 3 years after transplantation, graft survival was 72%, and KS prevalence was 28% (KS incidence: 8.2/yr/10 0 HHV-8(+) recipients). Multivariate analysis identified bacterial and/or P neumocystis carinii infection (odds ratio: 8.6; P = 0,019) and female gende r (odds ratio: 5.34; P = 0,047) as factors associated with KS, No KS was ob served in patients without anti-HHV-8 antibodies at the time of transplanta tion. Conclusions. The low graft survival and the high prevalence of KS within th e studied population of HHV-8(+) transplant recipients are strong arguments for systematic screening of HHV-8 serologic features before transplantatio n, especially in patients of African origin. HHV-8(+) transplant recipients should be closely monitored to severe infections.