Kaposi sarcoma in HIV-positive solid organ transplant recipients: A French multicentric national study and literature review

Background Kaposi sarcoma is a vascular tumor related to herpesvirus-8 and is promoted by immunosuppression. For the last 15 years, HIV patients have had access to organ transplantation. The dual immunosuppression of HIV and immunosuppressive treatments might increase the risk and severity of Kaposi sarcoma. Methods We conducted a multicentric retrospective study by collecting cases from French databases and society members of transplanted patients, among which 7 HIV-infected patients who subsequently developed Kaposi sarcoma were included. Results In the CRISTAL database (114 511 patients) and the DIVAT database (19 077 patients), the prevalence of Kaposi sarcoma was 0.18% and 0.46%, respectively, in transplanted patients; these values compare with 0.66% and 0.50%, respectively, in transplanted patients with HIV. The median time from HIV infection to Kaposi sarcoma was 20 years. Kaposi sarcoma occurred during the first year after transplantation in most cases, while HIV viral load was undetectable. Only 2 patients had visceral involvement. Five patients were treated with conversion of calcineurin inhibitor to mTOR inhibitor, and 5 patients were managed by decreasing immunosuppressive therapies. At 1 year, 4 patients had a complete response, and 3 had a partial response. Conclusions In our study, Kaposi sarcoma in transplanted patients with HIV did not show any aggressive features and was treated with the usual posttransplant Kaposi sarcoma management protocol. Corresponding authors' email addresses chloe.charpentier@aphp.fr julie.delyon@aphp.fr denis.glotz@aphp.fr marie-noelle.peraldi@aphp.fr jean-philippe.rerolle@chu-limoges.fr benoit.barrou@aphp.fr emilie.ducroux@chu-lyon.fr audreycoilly@gmail.com camille.legeai@biomedecine.fr stephane.barete@aphp.fr celeste.lebbe@aphp.fr Charpentier Chloé participated in the writing of the paper, participated in the research design, participated in the performance of the research, contributed new reagents or analytic tools, and participated in the data analysis Delyon Julie participated in the writing of the paper, participated in the research design, participated in the performance of the research, contributed new reagents or analytic tools, and participated in the data analysis Glotz Denis participated in the research design, participated in the performance of the research, and contributed new reagents or analytic tools Peraldi Marie-Noelle participated in the performance of the research and contributed new reagents or analytic tools Rerolle Jean-Philippe participated in the performance of the research and contributed new reagents or analytic tools Barrou Benoît participated in the performance of the research and contributed new reagents or analytic tools Ducroux Emilie participated in the performance of the research and contributed new reagents or analytic tools Coilly Audrey participated in the performance of the research and contributed new reagents or analytic tools Legeai Camille participated in the performance of the research and contributed new reagents or analytic tools Barete Stéphane participated in research design, participated in the performance of the research, and contributed new reagents or analytic tools Lebbé Céleste participated in the writing of the paper, participated in the research design, participated in the performance of the research, contributed new reagents or analytic tools, and participated in the data analysis Conflict of interest The authors declare no conflicts of interest. Funding No funding was received for this work Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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