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An In Vitro Model for Studying Cellular Transformation by Kaposi Sarcoma Herpesvirus
Published on: August 25, 2017
Efficacy of conversion to sirolimus in posttransplantation Kaposi's sarcoma
A Gutiérrez-Dalmau1, A Sánchez-Fructuoso, A Sanz-Guajardo
1Department of Nephrology and Renal Transplant Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain. adalmau@clinic.ub.es
Unlabelled:
The increased incidence of Kaposi's sarcoma (KS) in organ transplantation has been related to the KS herpes virus and the permissive effect of immunosuppressive therapy. We postulated that conversion to SRL in renal recipients with KS favored regression of KS lesions without increasing the risk of graft rejection.
Methods:
In this study we performed a retrospective chart review of 7 caucasian renal transplant recipients affected by KS to determine demographic data, etiology of ESRD, immunologic risk factors, immunosuppressive treatment, KS disease follow-up, and renal function before and after SRL conversion.
Results:
All seven patients were under calcineurin inhibitor treatment at the onset of KS which was limited to the skin, without regression despite attempts to minimize immunosuppression. After conversion to SRL, six patients showed progressive regression of KS lesions, with only hyperpigmented atrophic cutaneous lesions remaining after a mean time of 8.1 months (2-18 months). The seventh patient has completed 9 months follow-up with a near complete regression of KS lesions. One patient returned to hemodialysis after 13 months following irreversible acute renal failure not directly related to SRL conversion; in the other six, renal function was stable. The mean serum creatinine was 1.87 +/- 0.64 versus 1.74 +/- 0.68 mg/dL, pre-conversion versus the end of follow up, respectively. Mean SRL blood level was 9.2 +/- 2.0 ng/mL.
Conclusion:
After SRL conversion, patients with KS showed progressive regression without an increased risk of acute rejection. SRL offers a promising approach to the management of posttransplantation KS and probably other malignancies in organ transplant recipients.
Insights
Converting to sirolimus (SRL) in kidney transplant patients with Kaposi's sarcoma (KS) led to KS lesion regression. This immunosuppressive therapy change did not increase the risk of graft rejection, offering a promising management strategy.
Area of Science:
- Nephrology
- Oncology
- Transplantation Immunology
Background:
- Post-transplant Kaposi's sarcoma (KS) incidence is linked to KS herpes virus and immunosuppression.
- Immunosuppressive therapy can create a permissive environment for KS development.
Purpose of the Study:
- To evaluate the efficacy of switching to sirolimus (SRL) in renal transplant recipients with KS.
- To assess if SRL conversion favors KS lesion regression without increasing graft rejection risk.
Main Methods:
- Retrospective chart review of 7 Caucasian renal transplant recipients with KS.
- Analysis of demographic data, ESRD etiology, immunologic risk factors, immunosuppressive treatment, KS follow-up, and renal function pre- and post-SRL conversion.
Main Results:
- Six of seven patients showed progressive KS lesion regression after SRL conversion, with residual hyperpigmented lesions.
- One patient had near-complete KS regression after 9 months; renal function remained stable in six patients.
- Mean serum creatinine levels were comparable pre- and post-SRL conversion (1.87 vs. 1.74 mg/dL).
Conclusions:
- Sirolimus conversion in renal transplant recipients with KS promotes lesion regression.
- SRL conversion appears safe regarding acute graft rejection risk.
- Sirolimus presents a viable therapeutic option for post-transplantation KS and potentially other malignancies.
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