title: Sirolimus-associated lymphoedema: eight new cases and a proposed mechanism.
abstract: Sirolimus, an inhibitor of the mammalian target of rapamycin (mTOR), is increasingly used as an agent for post-transplant immunosuppression and the treatment of solid organ and haematological malignancies and hamartomas. Its advantages include a lack of nephrotoxicity and a lower incidence of nonmelanoma skin cancers; adverse effects include delayed wound healing, increased lymphocoele formation and rarely lymphoedema. We report a series of eight cases of severe, sustained, unilateral and bilateral lymphoedema in patients receiving sirolimus for post-transplant immunosuppression, classify their lymphoscintigraphy findings and propose a mechanism of aetiology based on the interaction of mTOR with key mediators of lymphangiogenesis.
authors.affiliation: Department of Dermatology, St George's Hospital, Tooting, London, UK. nemesha_desai@yahoo.co.uk
authors.forename: N
authors.initials: N
authors.lastname: Desai
authors.forename: S
authors.initials: S
authors.lastname: Heenan
authors.forename: P S
authors.initials: PS
authors.lastname: Mortimer
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008209:Lymphedema / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020123:Sirolimus / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus