Nephrol Dial Transplant (2002) 17: 892-896
© 2002 European Renal Association-European Dialysis and Transplant Association
Successful treatment of post-transplant Kaposi's sarcoma by reduction of immunosuppression
çi1
dil Ünal2çi11 Department of Nephrology and 2 Department of Dermatology, Ege University Medical School, Izmir, Turkey
Background. The aim of this study was to investigate retrospectively the clinical presentation, the efficacy of reducing immunosuppression and the consequences of this therapeutic approach in Kaposi's sarcoma (KS) developing after renal transplantation.
Methods. We reviewed the records of 502 patients who had been followed up at our transplantation unit between October 1, 1987 and December 30, 1998. Twelve patients (2.4%) with KS were included in the study.
Results. The mean age of KS patients was 38±11 years (one female, 11 males). All were on prednisone, azathioprine (AZT) and cylcosporin treatment. KS was encountered at a mean of 18±10 months post-renal transplantation. Typical Kaposi’s lesions were present in the skin of 11 out of l2 patients. In the only patient without skin involvement, who died from haemophagocytic histiocytic syndrome caused by septicaemia, KS was diagnosed post-mortem in a lymph node. In five patients only skin involvement was present, while the others also had visceral involvement (oropharynx in two patients, trachea and lung in three, lymph node in two, stomach and duodenum in two). Cyclosporin was stopped within 1 month after KS diagnosis, and AZT was stopped in three patients. Both cutaneous and visceral KS manifestations disappeared and no patient was lost due to KS. During a follow-up period 46±19 months, KS recurred in the lungs in one patient together with lung tuberculosis, while he was on prednisone and AZT. Two patients lost their graft due to chronic rejection. The remaining eight patients currently have a functioning graft with a mean creatinine level of 1.4±0.5 mg/dl.
Conclusion. KS is the most frequent post-transplant neoplasia (80%) in our country. In the present study cohort, half of the patients had visceral involvement. Reduction or discontinuation of immunosuppression caused complete remission in all patients without surgical intervention, chemotherapy or radiotherapy.
Keywords: Kaposi's sarcoma; kidney transplantation; malignancy
This study was presented as a poster presentation in the XXXVI Congress of the Fourth European Dialysis and Transplant Association, September 5–8, 1999.
Correspondence and offprint requests to: Soner Duman, Ege Üniversitesi Tip Fakültesi, Nefroloji Bilim Dali, Bornova 35100 Izmir, Turkey. Email: dumans{at}med.ege.edu.tr
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