Human Herpesvirus-8/Kaposi Sarcoma Herpesvirus in Solid Organ Transplantation: A Narrative Review of Neoplastic Manifestations

This comprehensive narrative review aims to provide an in-depth analysis of Human herpesvirus-8/Kaposi Sarcoma-associated herpesvirus (HHV-8/KSHV) and Kaposi sarcoma herpesvirus-associated diseases (KADs), with a special focus on malignancies in the setting of transplantation, by addressing the major issues related to clinical presentations, epidemiology, pathological features, diagnosis, treatment, and outcome. HHV-8/KSHV is an oncogenic virus belonging to the family of the γ-herpesvirus responsible for a wide range of KADs such as Kaposi’s Sarcoma (KS), multicentric Castleman disease (MCD), primary effusion lymphoma (PEL), diffuse large B cell lymphoma not otherwise specified (DLBCL-NOS), and KSHV inflammatory cytokine syndrome (KICS). In solid organ transplant (SOT) recipients, the incidence of HHV-8/KSHV-related malignancies are becoming more frequent because of prolonged life expectancy, and related aging and immunosenescence. HHV-8/KSHV infection in SOT is a rare but serious complication associated with significant morbidity and mortality. Enhanced clinical awareness of the diverse manifestations of KADs is critical for early diagnosis and improved outcomes. Multidisciplinary management is essential, given the complexity of these cases. Future research should focus on establishing standardized protocols for screening, diagnosis, and treatment to improve clinical outcomes. Targeted donors and recipients serological screening strategies, combined with vigilant post-transplant monitoring have the potential to enhance patient care.