title: Epstein-Barr virus-associated smooth muscle tumors after kidney transplantation: treatment and outcomes in a single center.
abstract: BACKGROUND
  Epstein-Barr virus-associated smooth muscle tumors (EBV SMT) in adult kidney transplant recipients (KTR) are rare. The aims of this study are to document the clinical features, types of treatment given, and outcomes of KTR with EBV SMT in our institution.
  
  
  METHODS
  Sixteen patients were identified from our institution's databases. Patients' survival, tumor outcome, and graft survival were compared between patients who remained on cyclosporine-based immunosuppressant and those who converted to sirolimus-based therapy.
  
  
  RESULTS
  The median time of diagnosis was 9.4 yr after kidney transplantation, and majority of the patients had multifocal disease at the time of diagnosis. Overall, the patient survival rate was 75% over a mean follow-up period of five yr. Two patients with non-functioning allograft at the time of diagnosis of EBV SMT were excluded from the treatment outcome analysis. Comparing the sirolimus (n = 7) vs. cyclosporine groups (n = 7), patient survival rate was 100% vs. 42.9% (p = 0.08), graft survival 71.4% vs. 28.7% (p = 0.53), and disease-free status 42.9% vs. 14.3% (p = 0.73), respectively.
  
  
  CONCLUSIONS
  Surgical resection in combination with decreasing immunosuppression or conversion to sirolimus appears to be effective in the treatment of EBV SMT in KTR.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore. tan.chieh.suai@sgh.com.sg
authors.forename: Chieh Suai
authors.initials: CS
authors.lastname: Tan
authors.forename: Hwai-Liang
authors.initials: HL
authors.lastname: Loh
authors.forename: Marjorie Wai Yin
authors.initials: MW
authors.lastname: Foo
authors.forename: Lina Hui Lin
authors.initials: LH
authors.lastname: Choong
authors.forename: Kok Seng
authors.initials: KS
authors.lastname: Wong
authors.forename: Terence Yi Shern
authors.initials: TY
authors.lastname: Kee
mesh_terms: D000328:Adult; D015331:Cohort Studies; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D018235:Smooth Muscle Tumor / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus
keywords: EBV-associated smooth muscle tumors; Epstein-Barr virus; immunosuppression; kidney; malignancy; post-transplant complications