Clinical features and course of Kaposi's sarcoma in kidney transplant patients: report of 13 cases.
We retrospectively evaluated the prevalence of Kaposi's sarcoma (KS) in 820 kidney transplant recipients with a follow-up period of at least 6 months. Thirteen patients developed a KS (1.6%): 2 were under conventional therapy and 11 under ciclosporin A. The onset of KS was 38.7 +/- 38.3 (range 6-124) months after transplantation in the whole population and after 33.9 +/- 19.7 months in the patients treated with ciclosporin A only. Nine were men and 4 women (male/female ratio: 2.25:1). The mean age at KS occurrence was 36.8 +/- 11.1 years. The mean follow-up period since KS diagnosis was 35.9 +/- 19.5 months. Clinical manifestation and severity of KS were heterogeneous: 5 patients had a KS with cutaneous involvement only, 8 patients a KS with multiple skin and mucosal and/or visceral lesions. Only 2 patients from the second group died of peritonitis due to intestinal lesions. In these 2 patients, immunosuppressive therapy had either been increased or reintroduced after a partial regression of KS. In all other patients, therapy was promptly reduced or withdrawn. In 1 patient local radiation therapy plus intralesional bleomycin administration were started and 1 patient received intralesional vincristine. Nine patients had a complete and 2 a partial remission of lesions. After therapy reduction, 4 patients lost their kidney (these patients however, had an already ongoing chronic rejection at KS diagnosis), in 2 there was an improvement of graft function, and in the other patients it remained stable. Our experience confirms that in most cases reduction or withdrawal of immunosuppression halts the evolution of both cutaneous and visceral lesions, without compromising graft function.(ABSTRACT TRUNCATED AT 250 WORDS)
Montagnino
G
G
Divisione di Nefrologia e Dialisi ed, Ospedale Maggiore IRCCS, Università di Milano, Italia.
Bencini
P L
PL
Tarantino
A
A
Caputo
R
R
Ponticelli
C
C
D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods*; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D011182:Postoperative Care; D015995:Prevalence; D012074:Remission Induction; D012514:Sarcoma, Kaposi / Q000453:epidemiology / Q000276:immunology*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000276:immunology*; D013997:Time Factors; D014181:Transplantation Immunology
D016572:Cyclosporine; D001379:Azathioprine; D008775:Methylprednisolone