Clin Transplant Res.  2025 Mar;39(1):77-83. 10.4285/ctr.24.0030.

Kaposi sarcoma of a liver graft in living donor liver transplantation: a rare case report

• Salimov U
• Balachandran P
• Semash K

• KMID: 2566583
• DOI: http://doi.org/10.4285/ctr.24.0030

Abstract

Kaposi sarcoma following solid organ transplantation is a rare and underreported complication, with few cases documented globally concerning its origin from liver grafts. This case report describes an Asian woman who developed Kaposi sarcoma in a liver graft following living donor liver transplantation for end-stage liver disease resulting from hepatitis D virus. In accordance with current guidelines, standard immunosuppression was discontinued, and mammalian target of rapamycin (mTOR) inhibitors were initiated. The use of mTOR inhibitors led to the complete resolution of the liver graft lesions within 9 months. However, subsequent follow-up revealed several complications, including late anastomotic biliary stricture, extensively drug-resistant Klebsiella pneumoniae infection, and subtotal hydrothorax. These complications required intensive care unit admission, biliary stenting, oxygen therapy, and pleural drainage. Despite the severity of her condition, the patient fully recovered and showed no signs of recurrence throughout the 64-month follow-up period. To our knowledge, this is the first reported case of Kaposi sarcoma in a liver graft with such an extended follow-up.

Keyword

Kaposi sarcoma; Liver transplantation; mTOR inhibitors; Case report

Figure

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  Fig. 1 Computed tomography (CT) scan, portal phase. Nine months following liver transplantation and 3 months after the diagnosis of Kaposi sarcoma. (A–C) CT revealed focal lesions in segments VI, VII, and VIII of the graft, most likely of vascular origin. The lesions varied in shape. (C) The focal liver lesions in segments VII and VIII were attached to the Glisson capsule. (D) Additionally, substantial swelling of the portal pedicle was noted, extending subsegmentally.

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  Fig. 2 Computed tomography (CT) scan, portal phase. Four months after the diagnosis of Kaposi sarcoma. (A) Structural changes of the segment VI lesion were observed compared to the previous follow-up. (B–D) CT demonstrated a partial tumor response. The focal liver lesions in segments V, VII, and VIII had decreased in size. (E) A marked decrease was evident in the swelling of the portal pedicle.

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  Fig. 3 Computed tomography (CT) scan, portal phase. Five months after the diagnosis of Kaposi sarcoma, CT demonstrated a continued tumor response. (А, B) Segment VI was stable, without a marked increase in size. No swelling of the portal pedicle was evident. (C, D) Segments V, VII, and VIII showed a sustained decrease in size.

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  Fig. 4 Computed tomography scan, portal phase. Sixteen months after the diagnosis of Kaposi sarcoma, a nearly complete tumor response was evident. On (A) coronal and (B) axial planes, lesions in segments V, VI, and VII were not observed.

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