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KSHV-Associated Diseases in Solid Organ Transplantation: Toward a Coordinated National Strategy in the United States
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DOI：10.1016/j.ajt.2026.07.028.png)
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Abstract
En 中文
Although Kaposi sarcoma–associated herpesvirus (KSHV)–associated disease (KAD) has long been recognized as a complication of transplantation, in the past five years, the incidence of KAD among solid organ transplant recipients in the United States has increased greater than five-fold, exposing gaps in screening and monitoring protocols. The United States lacks a coordinated framework for KSHV risk assessment and post-transplant monitoring, primarily because serologic and molecular testing is not yet widely available. Current laboratory-developed tests are not standardized across laboratories and analytes, testing capacity is insufficiently available nationwide and most tests are not approved for clinical use. This diagnostic gap limits the ability to define the KSHV status of donors and recipients before transplantation, distinguish graft-mediated transmission from reactivation of pre-existing infection, and interpret KAD risk across organ type and numerous host factors. International experiences and the HOPE in Action cohort in the US provide context, but do not readily translate into U.S. policy. We outline here priorities for a U.S. response, including generation of representative epidemiological data, diagnostic standardization, consensus testing and monitoring strategies, and clinician education to support safe, efficient, evidence-based organ utilization.
Keywords:
Human herpesvirus 8
Kaposi sarcoma–associated Herpesvirus
solid organ transplantation
Kaposi’s sarcoma
KSHV-associated disease
donor-derived infection
screening
post-transplant monitoring
viral diagnostics
CDC
Centers for Disease Control and Prevention
CLIA
Clinical Laboratory Improvement Amendments
ELISA
enzyme-linked immunosorbent assay
ERV-3
endogenous retrovirus 3
FDA
Food and Drug Administration
HBV
hepatitis B virus
HCV
hepatitis C virus
HIV
human immunodeficiency virus
HHV-8
human herpesvirus 8
HOPE
HIV Organ Policy Equity
IFA
indirect immunofluorescence assay
IgG
immunoglobulin G
KAD
KSHV-associated disease
KICS
KSHV inflammatory cytokine syndrome
KSHV
Kaposi sarcoma-associated herpesvirus
KS
Kaposi sarcoma
LANA
latency-associated nuclear antigen
LDT
laboratory-developed test
MCD
multicentric Castleman disease
mTOR
mechanistic target of rapamycin
MSM
men who have sex with men
MMWR
Morbidity and Mortality Weekly Report
OPTN
Organ Procurement and Transplantation Network
ORF
open reading frame
PBMC
peripheral blood mononuclear cells
PCR
polymerase chain reaction
PHS
Public Health Service
PWID
people who inject drugs
qPCR
quantitative polymerase chain reaction
SOT
solid organ transplant
U.K.
United Kingdom
U.S.
United States
WB
whole blood
Journal
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Organization
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