Kaposi's sarcoma in kidney transplant recipients: a 23-year experience.
BACKGROUND
Kaposi's sarcoma (KS) is a relatively common malignancy after kidney transplantation, accounting for up to 80% of all malignancies in developing countries.


OBJECTIVE
To assess the frequency of KS in renal transplant recipients, and determine the impact of demographic factors, immunosuppression and treatment options.


METHODS
Retrospective study in a single centre in South Africa.


METHODS
Charts and pathology reports of 542 recipients of 623 kidney allografts treated at our institution between 1976 and 1999 were reviewed.


RESULTS
After a mean follow-up of 6.4 years, 21 (3.9%) recipients had KS, representing 47.7% of all post-transplant malignancies. KS accounted for more post-transplant cancers in non-White than White patients (79.1% vs. 11.7%, p < 0.001). KS was equally common in males and females, and was not more frequent under cyclosporine. Skin involvement was universal; visceral disease occurred in six patients (28.6%). Sixteen (94.1%) patients with limited skin disease and two (100%) with superficial nodal disease responded to withdrawal or reduction of immunosuppression. Renal function was preserved when immunosuppression was reduced instead of withdrawn (p = 0.02). Patients with vital organ involvement succumbed rapidly to KS. Post-mortem examination revealed more extensive disease than was suspected clinically.


CONCLUSIONS
Ethnic differences exist in the frequency of KS in patients residing in the same geographical area. Since withdrawal results in graft loss, reducing immunosuppression should be first-line treatment for patients with disease limited to skin, and possibly for disease of the superficial lymph nodes. The malignant behaviour of KS, and extent of pathological involvement, cast doubt on the idea that KS is a hyperplasia rather than a true malignancy.
Moosa
M R
MR
Department of Internal Medicine, University of Stellenbosch and Renal Transplant Unit, Tygerberg Academic Hospital, Cape Town, South Africa, 7505. rmm@sun.ac.za
D000293:Adolescent; D000328:Adult; D044383:Black People; D002648:Child; D005260:Female; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000208:ethnology* / Q000276:immunology / Q000556:secondary / Q000628:therapy; D012878:Skin Neoplasms / Q000208:ethnology* / Q000276:immunology / Q000628:therapy; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome
D007166:Immunosuppressive Agents