Kaposi’s sarcoma following living donor kidney transplantation: review of 7,939 recipients
Tóm tắt
Kaposi’s sarcoma (KS) is one of the most common tumors to occur in kidney recipients, especially in the Middle East countries. Limited data with adequate sample size exist about the development of KS in living kidney recipients. Therefore, we made a plan for a multicenter study, accounting for up to 36% (n = 7,939) of all kidney transplantation in Iran, to determine the incidence of KS after kidney transplantation between 1984 and 2007. Fifty-five (0.69%) recipients who developed KS after kidney transplantation were retrospectively evaluated with a median follow-up of 24 (1–180) months. KS occurred more often in older age when compared to patients without KS (49 ± 12 vs. 38 ± 15 years, P = 0.000). KS was frequently found during the first 2 years after transplantation (72.7%). Skin involvement was universal. Furthermore, overall mortality rate was 18%, and it was higher in patients with visceral involvement compared to those with mucocutaneous lesions (P = 0.01). However, KS had no adverse affect on patient and graft survival rates compared to those without KS. Forty-four patients with limited mucocutaneous disease and four with visceral disease responded to withdrawal or reduction of immunosuppression with or without other treatment modalities. Renal function was preserved when immunosuppression was reduced instead of withdrawn in patients with and without visceral involvement (P = 0.001 and 0.008, respectively). The high incidence of KS in this large population studied, as compared to that reported in other transplant patient groups, suggests that genetic predisposition may play a pathogenetic role.
Tài liệu tham khảo
Einollahi B (2007) Kaposi sarcoma after kidney transplantation. IJKD 1:2–11
Chiang YJ, Chen CH, Wu CT et al (2004) De Novo cancer occurrence after renal transplantation: a medical center experience in Taiwan. Transplant Proc 36:2150–2215. doi:10.1016/j.transproceed.2004.08.013
Kasiske BL, Vazquez MA, Harmon WE et al (2000) Recommendation for the outpatient surveillance of renal transplant recipients. J Am Soc Nephrol 11:S1–S86
Penn I (1995) Sarcomas in organ allograft recipients. Transplantation 60:1485–1491
Frances C (1998) Kaposi’s sarcoma after renal transplantation. Nephrol Dial Transplant 13:2768–2773. doi:10.1093/ndt/13.11.2768
Einollahi B, Taheri S (2008) Renal transplantation practice in Iran and the Middle East: report from Iran and a review of the literature. Ann Transplant 13:5–14
Nafar M, Einollahi B, Hemati K, Poor Reza Gholi F, Firouzan A (2005) Development of malignancy following living donor kidney transplantation. Transplant Proc 37:3065–3067. doi:10.1016/j.transproceed.2005.08.011
Shahbazian H (2004) Kaposi sarcoma in kidney transplanted patients. Urol J 1:111–114
Einollahi B, Nourbala MH, Lessan-Pezeshki M et al (2001) Incidence of postrenal transplantation malignancies: a report of two centers in Tehran, Iran. Transplant Proc 33:2812–2813. doi:10.1016/S0041-1345(01)02199-6
Lessan-Pezeshki M, Einollahi B, Khatami MR, Mahdavi M (2001) Kidney transplantation and Kaposi’s sarcoma: review of 2052 recipients. Transplant Proc 33:2818−2819. doi:10.1016/S0041-1345(01)02203-5
Euvrard S, Kanitakis J, Claudy A (2003) Skin cancers after organ transplantation. N Engl J Med 348:1681–1691. doi:10.1056/NEJMra022137
Qunibi WY, Barri Y, Alfurayh O, Almeshari K, Khan B, Taher S, Sheth K (1993) Kaposi’s sarcoma in renal transplant recipients: a report on 26 cases from a single institution. Transplant Proc 25:1402–1405
Harwood AR, Osoba D, Hofstader SL et al (1979) Kaposi’s sarcoma in recipients of renal transplants. Am J Med 67:759–765. doi:10.1016/0002-9343(79)90731-9
Penn I (1986) The occurrence of malignant tumors in immunosuppressed states. Prog Allergy 37:259–300
Montagnino G, Bencini PL, Tarantino A, Caputo R, Ponticelli C (1994) Clinical features and course of Kaposi’s sarcoma in kidney transplant patients: report of 13 cases. Am J Nephrol 14:121–126
Qunibi W, Akhtar M, Sheth K et al (1988) Kaposi’s sarcoma: the most common tumor after renal transplantation in Saudi Arabia. Am J Med 84:225–232. doi:10.1016/0002-9343(88)90418-4
Szende B, Toth A, Perner F, Nagy K, Takacs K (1997) Clinicopathologic aspects of 8 Kaposi’s sarcomas among 1009 renal transplant patients. Gen Diagn Pathol 143:209–213
Penn I (1979) Kaposi’s sarcoma in organ transplant recipients: report of 20 cases. Transplantation 27:8–11
Gotti E, Remuzzi G (1997) Post-transplant Kaposi’s sarcoma. J Am Soc Nephrol 8:130–137
Shepherd FA, Maher E, Cardella C, Cole E, Greig P, Wade JA et al (1997) Treatment of Kaposi’s sarcoma after solid organ transplantation. J Clin Oncol 15:2371–2377
Antman K, Chang Y (2000) Kaposi’s sarcoma. N Engl J Med 342:1027–1038. doi:10.1056/NEJM200004063421407
Firoozan A, Hosseini Moghaddam SM, Einollahi B et al (2005) Outcome of Kaposi’s sarcoma and graft following discontinuation of immunosuppressive drugs in renal transplant recipients. Transplant Proc 37:3061–3064. doi:10.1016/j.transproceed.2005.07.042
al-Sulaiman MH, al-Khader AA (1994) Kaposi’s sarcoma in renal transplant recipients. Transplant Sci 4:46–60