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Kidney transplantation and kaposi’s sarcoma: review of 2050 recipients
Kidney Transplantation and Kaposi’s Sarcoma: Review of 2050 Recipients M. Lessan-Pezeshki, B. Einollahi, M.R. Khatami, and M. Mahdavi
T
HE FIRST CASE of post-renal transplantation KS was reported in 1969, and since then a number of reports have confirmed the high incidence of this cancer among immunosuppressed transplant recipients. Until 1980, the transplant literature reported few cases of KS in recipients of organ grafts.1 The aim of this study was to determine the prevalence of KS in our kidney transplant group. MATERIALS AND METHODS A total of 2050 kidney graft recipients (KGRs) who received organs between 1984 and 1999 were surveyed for the involvement of KS; 1320 KGRs received triple therapy, where as 730 patients were treated with cyclosporine and prednisone. In these two groups, 215 patients received monoclonal or polyclonal antibodies during induction therapy.
RESULTS
Eighteen patients developed KS (0.87%), all of them under cyclosporine therapy. The onset of KS was on average 26 ⫾ 25.8 months after transplantation (range 5 to 125 months); 13 were men and five were women (male/female ratio: 2.6:1). Cutaneous lesions were detected in all patients; one patient also had visceral involvement. Elevated titer for CMV occurred for 25%. None of them were positive for HIV. Treatment was promptly reduced or withdrawn in all patients. Eleven had a complete remission and seven had a partial remission of lesions, which responded to chemotherapy. After therapy reduction, four patients lost their kidney
0041-1345/01/$–see front matter PII S0041-1345(01)02203-5 2818
function; graft function remained stable in all other patients. DISCUSSION
With the use of potent immunosuppressive agents, malignancies have arisen as an important factor of morbidity and mortality in transplant recipients. The average interval between organ transplantation and the onset of KS is 20 months, ranging from a few weeks to 18 years. This average time interval is around 12 months in recipients treated with cyclosporine.2 In our study this time interval is a little bit longer. The development of neoplasm could reflect a decreased capacity of the host to destroy cells harboring latent HHV-8 because of continuous immunosuppression. Our study shows that simple reduction or cessation of immunosuppression may result in partial or complete remission of the disease. REFERENCES 1. Bronson DM: In Gottlieb G, Ackerman AB (eds); Kaposi’s Sarcoma: A Text and Atlas. Philadelphia; Lea and Febiger, 1988, p 241 2. Penn I: Transplant Proc 20(suppl 1):276, 1988 From the Tehran Medical Science University, Tehran, Iran. Address reprint requests to M. Lessan-Pezeshki, Tehran Medical Science University, Kashani Expway, Golha Avenue, 6th Street No: 13, Code: 14718, Tehran, Iran.
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Transplantation Proceedings, 33, 2818 (2001)
T
HE FIRST CASE of post-renal transplantation KS was reported in 1969, and since then a number of reports have confirmed the high incidence of this cancer among immunosuppressed transplant recipients. Until 1980, the transplant literature reported few cases of KS in recipients of organ grafts.1 The aim of this study was to determine the prevalence of KS in our kidney transplant group. MATERIALS AND METHODS A total of 2050 kidney graft recipients (KGRs) who received organs between 1984 and 1999 were surveyed for the involvement of KS; 1320 KGRs received triple therapy, where as 730 patients were treated with cyclosporine and prednisone. In these two groups, 215 patients received monoclonal or polyclonal antibodies during induction therapy.
RESULTS
Eighteen patients developed KS (0.87%), all of them under cyclosporine therapy. The onset of KS was on average 26 ⫾ 25.8 months after transplantation (range 5 to 125 months); 13 were men and five were women (male/female ratio: 2.6:1). Cutaneous lesions were detected in all patients; one patient also had visceral involvement. Elevated titer for CMV occurred for 25%. None of them were positive for HIV. Treatment was promptly reduced or withdrawn in all patients. Eleven had a complete remission and seven had a partial remission of lesions, which responded to chemotherapy. After therapy reduction, four patients lost their kidney
0041-1345/01/$–see front matter PII S0041-1345(01)02203-5 2818
function; graft function remained stable in all other patients. DISCUSSION
With the use of potent immunosuppressive agents, malignancies have arisen as an important factor of morbidity and mortality in transplant recipients. The average interval between organ transplantation and the onset of KS is 20 months, ranging from a few weeks to 18 years. This average time interval is around 12 months in recipients treated with cyclosporine.2 In our study this time interval is a little bit longer. The development of neoplasm could reflect a decreased capacity of the host to destroy cells harboring latent HHV-8 because of continuous immunosuppression. Our study shows that simple reduction or cessation of immunosuppression may result in partial or complete remission of the disease. REFERENCES 1. Bronson DM: In Gottlieb G, Ackerman AB (eds); Kaposi’s Sarcoma: A Text and Atlas. Philadelphia; Lea and Febiger, 1988, p 241 2. Penn I: Transplant Proc 20(suppl 1):276, 1988 From the Tehran Medical Science University, Tehran, Iran. Address reprint requests to M. Lessan-Pezeshki, Tehran Medical Science University, Kashani Expway, Golha Avenue, 6th Street No: 13, Code: 14718, Tehran, Iran.
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Transplantation Proceedings, 33, 2818 (2001)