Kaposi Sarcoma Herpesvirus-Associated Diseases in Solid Organ Transplantation: Toward a Coordinated National Strategy in the United States

Although Kaposi sarcoma-associated herpesvirus (KSHV)-associated disease (KAD) has long been recognized as a complication of transplantation, in the past 5 years, the incidence of KAD among solid organ transplant recipients in the United States has increased greater than 5-fold, exposing gaps in screening and monitoring protocols. The United States lacks a coordinated framework for KSHV risk assessment and posttransplant 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 preexisting infection, and interpret KAD risk across organ type and numerous host factors. International experiences and the Human Immunodeficiency Virus Organ Policy Equity Act in action cohort in the US provide context, but do not readily translate into US policy. We outlined here priorities for a US response, including generation of representative epidemiologic data, diagnostic standardization, consensus testing and monitoring strategies, and clinician education to support safe, efficient, evidence-based organ utilization.