An early Kaposis sarcoma after Kidney transplantation that was treated by sirolimus
dr farzaneh najafi Assistant professor of Shahid Sadooghi University of Medical Sciences,Department of nephrology1 dr parichehr kafaie Assistant professor of Shahid Sadooghi University of Medical Sciences,Department of dermathology2
Long-term immunosuppression in kidney transplantation recipient increases the risk of malignancy(1). Kaposi ’s sarcoma (KS) is one of these tumors(2) . It develops in 0/06% to 4% of renal transplant recipients(3).The differences in incidence are dependent to geographic and ethnic variation, the immunosuppressive regimen, genetic and environment factors(4). An increased risk of post-transplant KS may be related to HHV-8 infection and pre transplantation HHV-8 seropositivity is a risk factor(5).KS has been reported to occur a few months to 18 years after transplantation(6).The mean interval that reported was about 12.2 months(7).The ratio of male to female is 3.3:1 to 1:1,and the mean age at the time of diagnosis is 43 years,which is younger than among patients with classic KS(8).
Here we describe a case of a 50-year old man who developed KS a few months after kidney transplantation.The cause of ESRD in patient was idiopathic cresentic glomerulonephritis and he has been managed with hemodialysis for two years before transplantation.
The immunosuppressive therapy for him was contained of prednisolone, tacrolimus (Prograf) and mycophenolate mofetil .
About eight months after his transplantation, his complaints were some purple-red brown nodules on both legs and one arm .He explained that these skin lesion gragually appeared from three months ago. As soon ,he was referred to dermatologist, and after his skin biopsy, it was determined that he had KS.
After that, he was referred to hematologist, and it was determined that he had only cutaneous KS.The pre transplant serology showed negative tests for hepatitis B surface antigen,anti-HCV and HIV.High plasma levels of specific immunoglobulinG were found indicating previous infections by cyto-megalo virus,herpes simplex,varicella-zoster and Epstein-Barr, and these serology remained intact after transplantation.
The immunosuppressive therapy was firstly,tapered and thenafter tacrolimus and mycophenolate mofetil withdrawn,but sirolimus started, and prednisolone was continued.
Gragually the skin nodule on his arm and left leg and one nodule on right leg disappeared,and the others nodule on right leg was decreased and had considered recovery.
Firstly,malignancy is an important cause of mortality and morbidity after kidney transplantation,and since skin cancer is the most common tumor associated with transplantation,and skin lesions are encountered in more than 90% of KS, it seems that the examination of skin should be a part of regular follow up and dermatologist examination is recommended every 6 months. Secondly,cutaneouse KS could have complete remission in response to sirolimus therapy.