Kaposi's sarcoma after liver transplantation.
BACKGROUND
Kaposi's Sarcoma (KS) is a malignant neoplasm arising from endothelial cells. HHV8-infection represents a key pathogenic determinant for the development of KS. There are no standard criteria to treat KS in immunosuppressed-individuals. Six cases (2.1%) of KS occurred in our Center among 285-recipients who underwent liver transplantation (LT) between October 2000 and November 2006.


METHODS
Patients were four males and two females. Mean age was 57 years (range 44-65). Indication for LT was ESLD associated/non-associated with hepatocellular carcinoma (HCC). The immunosuppressive regimen consisted of cyclosporine/tacrolimus associated with steroids or daclizumab. HHV8-detection was performed by the serological method before LT, and by polymerase chain reaction (PCR)-analysis after KS.


RESULTS
One patient had HCV-related cirrhosis and coinfection from HIV, three had HBV-related cirrhosis, two of these with coexistent HCC. The last two patients had alcoholic-cirrhosis, one with coexistent HCC. Mean time from transplantation to KS was 6.2 months (range 3.8-8.8). Three patients were treated with doxorubicin and three with switch from calcineurin-inhibitors to sirolimus. Three patients expired after 11.5, 8.8, and 7.4 months from KS diagnosis.


CONCLUSIONS
KS should be treated by a multidisciplinary approach to obtain an early diagnosis and best management. Effective treatment with immunosuppression reduction or switch to sirolimus is mandatory and can induce complete regression.
Di Benedetto
Fabrizio
F
Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Via del Pozzo, 71-41100 Modena, Italy. f.diben@virgilio.it
Di Sandro
Stefano
S
De Ruvo
Nicola
N
Berretta
Massimiliano
M
Masetti
Michele
M
Montalti
Roberto
R
Ballarin
Roberto
R
Cocchi
Stefania
S
Potenza
Leonardo
L
Luppi
Mario
M
Gerunda
Giorgio E
GE
D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D019288:Herpesvirus 8, Human / Q000302:isolation & purification; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012514:Sarcoma, Kaposi / Q000209:etiology* / Q000628:therapy
D016572:Cyclosporine