title: Sirolimus for the treatment of Kaposi sarcoma after renal transplantation: a series of 10 cases.
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 Immunosuppressive treatment was reduced, then withdrawn in three cases, resulting in regression of KS a few weeks later, but with graft loss requiring hemodialysis at 1, 3 and 4 months.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.
authors.affiliation: Department of Nephrology, Hedi Chaker Hospital, Sfax, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Yaich
authors.forename: K
authors.initials: K
authors.lastname: Charfeddine
authors.forename: S
authors.initials: S
authors.lastname: Zaghdane
authors.forename: N
authors.initials: N
authors.lastname: El Aoud
authors.forename: F
authors.initials: F
authors.lastname: Jarraya
authors.forename: M
authors.initials: M
authors.lastname: Kharrat
authors.forename: J
authors.initials: J
authors.lastname: Hachicha
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000276:immunology*; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008175:Lung Neoplasms / Q000453:epidemiology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012514:Sarcoma, Kaposi / Q000453:epidemiology / Q000276:immunology*; D020123:Sirolimus / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000276:immunology*; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000276:immunology*; D013997:Time Factors; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus