Successful Treatment of Liver Transplant-Associated Kaposi’s Sarcoma With Long-Term Vincristine

Enhanced anticancer effect of Combretastatin A-4 phosphate when combined with vincristine in the treatment of hepatocellular carcinoma

Tubulin targeting agents have received considerable interest as a potential tumor-selective vascular disrupting agents, which represent another avenue for cancer growing therapeutic opportunities. Hence, the present study was conducted to investigate the anti-tumor activity of Combretastatin A-4 phosphate (CA4-P) and vincristine against hepatocellular carcinoma in rats, by individual administration and in combination. In vitro study was conducted using human hepatocellular carcinoma cell lines, showed that CA4-P and vincristine have a potent cell cytotoxic and tubulin inhibitory effect. In addition, a remarkable synergistic effect was observed by the simultaneous application of both drugs. Whereas in vivo study was conducted using model of rat liver cancer initiated with DENA and promoted by CCl₄, showed that CA4-P and vincristine were significantly decreased liver relative weight, number of hepatic nodules and there relative volumes, tubulin content of the hepatic tissue, GSH and AFP. On the other hand, co-administration of both drugs exhibited significant further decrements in these parameters. Whereas a marked increase in MDA, carbonyl content and TNF-α inside hepatic tissue were observed in the treated groups and these increments were more prominent by co-administration of both drugs. In conclusion CA4-P showed a potential anti-cancer activity against hepatocellular carcinoma and this effect was greatly enhanced by co-administration with vincristine. Additionally, our new findings provided an important evidence that the anticancer activity of drugs with a narrow therapeutic window such as vincristine can be greatly improved by its co-administration with CA4-P providing more enhanced activity with less side effects.

Kaposi's sarcoma after liver transplantation from a donor with a history of ventriculoperitoneal shunt and craniotomy for primary central nervous system lymphoma: report of a case

The transplantation of organs from donors who have undergone shunt surgery or craniotomy for a malignant central nervous system (CNS) tumor is controversial. We report a case of Kaposi's sarcoma (KS) developing as a result of immunosuppression in the recipient of a liver transplant from a donor who underwent craniotomy and ventriculoperitoneal shunt surgery for primary CNS lymphoma. Polymerase chain reaction assay did not isolate human herpes virus-8 in the Kaposi lesions. To our knowledge, this is the only case ever reported of KS developing after liver transplantation from a donor with lymphoma. Thus, with appropriate screening to exclude possible dissemination, patients with a history of high-grade primary CNS lymphoma treated by ventriculoperitoneal shunt and craniotomy may be accepted as donors.

Dermatologic complications after liver transplantation: a single-center experience

OBJECTIVE

To report our experience with dermatological complications after both deceased donor liver transplantation (DDLT) and living-donor liver transplantation (LDLT).

PATIENTS AND METHODS

Between April 2001 and November 2006, a total of 116 liver transplantation (LT) procedures were performed (73 DDLTs and 43 LDLTs) in 112 patients (4 re-transplants). Posttransplant dermatological problems were recorded.

RESULTS

Among 112 OLT recipients, 14 patients (12.5%) experienced dermatologic problems: epidermolysis bullosa acquisita in one patient, which was self-limiting; graft-versus-host-disease in one patient treated with high-dose steroids; Kaposi sarcoma in one patient treated with surgical excision and conversion to sirolimus-based immunosuppression; drug-induced cutaneous vasculitis with deep thigh ulcer formation treated by drug discontinuation and surgical excision of the ulcer; herpes zoster in one patient treated with intravenous antiviral therapy; herpes simplex in two patients treated with local antiviral cream; cyclosporine-induced gingival hyperplasia treated with conversion to FK506; cyclosporine-induced hypertrichosis treated with conversion to FK506; steroid-induced skin hyperpigmentation in one patient treated with steroid withdrawal; hypomagnesemia-induced hair loss treated with daily oral magnesium supplement; pressure-induced alopecia areata in two patients that was self-limiting; and finally, one patient with a pressure-induced heel ulcer that was treated conservatively. In 8 of 14 patients (57%) who suffered from dermatologic problems, the complication was primarily related to immunosuppressive drugs.

CONCLUSIONS

In our experience, dermatologic complications following LT are not uncommon and usually related to immunosuppressive therapy. Most complications could be prevented by optimizing immunosuppression. The majority of complications were easily managed by simple adjustment of immunosuppression.