Elsevier

Transplantation Proceedings

Volume 44, Issue 9, November 2012, Pages 2824-2826
Transplantation Proceedings

11th congress of the french speaking society of transplantation
Kidney transplantation: Complications
Sirolimus for the Treatment of Kaposi Sarcoma After Renal Transplantation: A Series of 10 Cases

https://doi.org/10.1016/j.transproceed.2012.09.025Get rights and content

Abstract

The incidence of Kaposi sarcoma (KS) has substantially increased among immunocompromised patients, suggesting a role for immunosuppressive drugs. The aim of this study was to evaluate the incidence, features, and outcome of KS among 307 kidney transplantation patients at our center between January 1994 and June 2010. During the study period, the 10 patients who developed KS (3.25%) showed a mean age at transplantation of 35.8 ± 8.7 years (range, 22 to 49 years). The mean interval between transplantation and occurrence of KS was 24.7 ± 21.36 months (range, 6 to 64 months). The mean time of antithymocyte globulin induction was 9.5 days (range, 6 to 13 days). KS was restricted to the skin in 7 cases, among which, one presented with associated Hodgkin lymphoma. Visceral involvement (one lung and one colon) was observed in two cases. One patient presented with a gastric KS without skin lesions. Immunosuppressive treatment was reduced, then withdrawn in three cases, resulting in regression of KS a few weeks later, but with graft loss requiring hemodialysis at 1, 3 and 4 months. Among the remaining 7 cases, we stopped mycophenalate mofetil (MMF) and switched from calcineurin inhibitors to sirolimus. Allograft function remained stable after the switch. Only one patient who already had allograft dysfunction due to biopsy-proven chronic allograft nephropathy. Deteriorated progressively, undergoing hemodialysis at 2 years after KS diagnosis. In conclusion, we observed a relatively high incidence of KS among our cases. The introduction of sirolimus resulted in complete regression of KS lesions with preserved graft function.

Section snippets

Patients and Methods

We studied 307 kidney transplant recipients who underwent renal transplantations at our center between January 1994 and June 2010. All patients received induction treatment with polyclonal antibodies (antithymocyte globulins; ATG) and prednisolone (10 mg/kg/d). There were two distinct maintenance immunosuppressive regimens: from 1994 to 2003 we prescribed azathioprine (2 mg/kg/d), cyclosporine (5 mg/kg/d), and prednisone (10 mg/d), and from 2003 onwards, mycophenolate mofetil (MMF 2 g/d, then 1

Results

During the study period, 10 of 307 (3.25%) patients developed KS. The mean age of affected individuals at transplantation was 35.8 ± 8.7 years (range, 22 to 49 years). The 10 KS subjects included 7 males and 3 females. Their mean interval time between transplantation and KS occurrence was 24.7 ± 21.36 months (range, 6 to 64 months). The mean length of ATG treatment was 9.5 days (range, 6 to 13 days). Their mean duration of hemodialysis before transplantation was 41 ± 40.3 months (range, 1 to

Discussion

The incidence of KS among solid organ transplant recipients is 500 times that among the general population, suggesting a role for immunosupression in the development of the disease. HHV8 infection has been incriminated in the pathogenesis of KS lesions. In fact, the geographic distribution and detection of DNA fragments of HHV8 in KS skin lesions are suggestive of an infectious cause.1

The mean interval time between kidney transplantation and KS diagnosis is 29 to 31 months (range, 3 to 124

References (11)

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