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Saowapa S, Polpichai N, Siladech P, Wannaphut C, Tanariyakul M, Wattanachayakul P, Lalitnithi P. Evaluating Kaposi Sarcoma in Kidney Transplant Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52527. [PMID: 38371002 PMCID: PMC10874301 DOI: 10.7759/cureus.52527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Kaposi's sarcoma (KS) is a malignancy that commonly appears as lesions on the skin or mucosal surfaces but can also develop in other organs. This cancer is usually caused by the human herpesvirus 8 (HHV-8), recently known as Kaposi's sarcoma-associated herpesvirus (KSHV). KS is rare in the general population but can develop in kidney transplant recipients with varying incidence due to immunocompromised status from immunosuppression. The main aim of the present systematic review was to identify the prevalence and treatment of KS in kidney transplant patients. PubMed, Cochrane Library, and Google Scholar databases were searched for studies until October 2023. Full-text studies with similar research objectives were included, while non-English articles, reviews, case reports, ongoing clinical trials, and studies evaluating KS in HIV patients or after other solid organ transplants were excluded. All studies were observational; therefore, methodological quality was assessed using the Newcastle-Ottawa Scale. The statistical analyses were performed with the Comprehensive Meta-Analysis (CMA) software (Biostat, Inc. Englewood, NJ). The pooled analysis from the 15 studies included showed that KS develops in 1.5% of kidney transplant recipients and is more prevalent in African (1.7%) and Middle Eastern (1.7%) recipients than in Western recipients (0.07%). KS was also significantly more prevalent among male recipients than female recipients (OR: 2.36; p < 0.0001). Additionally, cyclosporine-based immunosuppression accounts for most KS incidences (79.6%) compared to azathioprine-based immunosuppression (28.2%). Furthermore, reduction or withdrawal of immunosuppression alone resulted in 47.8% KS complete remissions. Post-kidney transplantation KS is more frequent among males and patients of Middle Eastern and African origin. However, the gender difference may be attributed to most patients undergoing kidney transplants being male. Therefore, if gender balance is considered in future studies, then the difference might be insignificant. Based on our results, we can concur that the mainstay treatment for post-transplant KS is reduction or withdrawal of immunosuppression. However, the patients should be closely monitored to avoid KS recurrence and kidney rejection. Furthermore, there is an increased risk for KS with the use of cyclosporine-based immunosuppression. However, this does not mean that the withdrawal of this immunosuppression agent might result in improved KS outcomes because the withdrawal of azathioprine with or without cyclosporine reduction has also led to improved outcomes.
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Affiliation(s)
- Sakditad Saowapa
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | | | - Chalothorn Wannaphut
- Internal Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
| | - Manasawee Tanariyakul
- Internal Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
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Khanmammadov N, Paksoy N, Doğan İ, Ferhatoğlu F, Saip P, Aydiner A. Efficacy and outcomes of systemic chemotherapy in posttransplant and immunosuppression associated Kaposi sarcoma: Twenty years experience of a tertiary cancer center. Medicine (Baltimore) 2023; 102:e35383. [PMID: 37773844 PMCID: PMC10545387 DOI: 10.1097/md.0000000000035383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
Kaposi sarcoma is a malignant angioproliferative disease, and human herpesvirus-8 plays a major role in its etiology. Iatrogenic Kaposi sarcoma (IKS) can occur in patients undergoing immunosuppressive therapy. The treatment strategy for patients with IKS is immunosuppressive therapy modification. However, it is unclear which chemotherapy drug is the most effective and safe in the treatment of IKS. Therefore, we investigated the efficacy and safety of systemic treatment in patients with IKS at our tertiary cancer center. This cross-sectional retrospective study analyzed the clinical data of 22 patients diagnosed with IKS between January 2000 and January 2020. The patients were divided into the following 2 groups according to the transplantation status: organ transplant recipient (OTR) group and non-organ transplant recipient (non-OTR) group. Of the 22 patients, 12 were included in the OTR group and 10 were included in the non-OTR group. The median patient age at diagnosis was 52.1 years in the OTR group and 68.1 years in the non-OTR group. The median overall survival (OS) was 65.4 months in the OTR group, while the median OS was not reached in the non-OTR group. There was no statistically significant difference in OS between the 2 groups (P = .45). The 5-year OS rate among all patients was 54%. In the OTR group, the objective response rate and disease control rate were 50% and 83%, respectively, and in the non-OTR group, the objective response rate and disease control rate were 60% and 90%, respectively. Chemotherapy was well tolerated in both groups. Hematological toxicities were the main dose-limiting adverse events. Grade III/IV leucopenia and neutropenia were observed in 5 and 4 patients, respectively; however, no patient experienced febrile neutropenia. No chemotherapy-related death occurred. Systemic chemotherapy is an effective treatment and can be considered for disease control in patients with an aggressive disease course, who do not experience regression with immunosuppressive therapy modification.
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Affiliation(s)
- Nij̇at Khanmammadov
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - İzzet Doğan
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Ferhat Ferhatoğlu
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
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Nyeko R, Geriga F, Angom R, Kambugu JB. Oral-visceral iatrogenic Kaposi sarcoma following treatment for acute lymphoblastic leukemia: a case report and review of the literature. J Med Case Rep 2022; 16:405. [PMID: 36329498 PMCID: PMC9635084 DOI: 10.1186/s13256-022-03620-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background There have hardly been any reported cases of children presenting with Kaposi sarcoma as a second malignancy following treatment for acute lymphoblastic leukemia outside a transplant setting. Case presentation We report a case of a 5-year-old boy of Bantu origin, which, to our knowledge, could be only the second reported case of oral–visceral Kaposi sarcoma after acute lymphoblastic leukemia treatment. The patient presented with a 1-month history of progressive, non-painful, soft tissue oral mass, 1 month after completing treatment for high-risk acute lymphoblastic leukemia. He was successfully treated for Kaposi sarcoma on a two-drug regimen (bleomycin and vincristine) with good clinical response. Conclusion Visceral Kaposi sarcoma as a second malignancy may occur after pediatric acute lymphoblastic leukemia treatment, but its rarity makes it unlikely to raise suspicion among clinicians, thus precluding early diagnosis and treatment. We recommend routine evaluation for Kaposi sarcoma lesions in children undergoing long-term surveillance following treatment for childhood acute leukemia. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-022-03620-3.
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Affiliation(s)
- Richard Nyeko
- grid.512320.70000 0004 6015 3252Department of Paediatric Oncology, Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda ,Department of Paediatrics and Child Health, Lira University, P.O. Box 1035, Lira, Uganda
| | - Fadhil Geriga
- grid.512320.70000 0004 6015 3252Department of Paediatric Oncology, Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda
| | - Racheal Angom
- grid.512320.70000 0004 6015 3252Department of Paediatric Oncology, Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda
| | - Joyce Balagadde Kambugu
- grid.512320.70000 0004 6015 3252Department of Paediatric Oncology, Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda
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Story MT, Sanders ML, Bashir AA, Longo JM, Abel SL, Dollard SC, Grodstein EI, Thomas CP, Katz DA. Infiltrating Kaposi sarcoma presenting as acute kidney injury: An unexpected consequence of deliberate hepatitis C-positive organ transplantation. Transpl Infect Dis 2021; 23:e13481. [PMID: 33012057 DOI: 10.1111/tid.13481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
Kaposi sarcoma (KS) following kidney transplantation can result from recipient reactivation of latent human herpesvirus 8 (HHV-8) infection or activation of donor-acquired HHV-8 infection. Post-transplant KS typically manifests with cutaneous pathology, but rare cases of renal allograft involvement have been reported. We describe two cases of donor-derived HHV-8 infection in two hepatitis C (HCV) viremia-negative transplant recipients who each received a kidney from a donor with HCV viremia. One recipient did not develop KS while the other presented with acute kidney injury caused by extensive KS infiltration of the renal parenchyma and metastatic disease. This report reviews the literature for cases of KS involving the renal allograft and highlights an unexpected consequence of deliberate HCV-positive organ transplantation.
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Affiliation(s)
- Maria T Story
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - M Lee Sanders
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
- Iowa City VA Health Care System, Iowa City, IA, USA
| | - Amani A Bashir
- Department of Pathology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - Jude M Longo
- Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Radiology, University of Iowa Roy and Lucille Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Stacy L Abel
- Iowa City VA Health Care System, Iowa City, IA, USA
| | | | - Elliot I Grodstein
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Christie P Thomas
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
- Iowa City VA Health Care System, Iowa City, IA, USA
| | - Daniel A Katz
- Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Surgery, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
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Giannis D, Moris D, Ishum Shaw B, Vernadakis S. Primary thoracic chondrosarcoma with intra-abdominal extension in a renal transplant recipient: A case report. Mol Clin Oncol 2020; 13:63-66. [PMID: 32551110 DOI: 10.3892/mco.2020.2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/18/2020] [Indexed: 11/05/2022] Open
Abstract
Primary thoracic bone tumors are relatively rare. The most common type is chondrosarcoma, accounting for up to 48% of all cases. Patients with primary thoracic bone tumors commonly present with atypical thoracic pain or a solitary palpable chest mass, which gradually develops over months to years. The bones most often affected are the ribs, scapula, costochondral junctions and the sternum. The present study presents a case of a 79 year old previous transplant recipient with a large intra-abdominally expanding chondrosarcoma originating from the left lower thoracic cage and associated vague abdomdinal symptoms. Early recognition and awareness of atypical presentations of this disease are important in to appropriately guide diagnostic evaluation and therapeutic procedures.
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Affiliation(s)
- Dimitrios Giannis
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Dimitrios Moris
- Duke Surgery, Duke University Medical Center, Durham, NC 27710, USA.,Transplantation Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Brian Ishum Shaw
- Duke Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Boere T, Huis In 't Veld EA, Deroose JP, van Ginhoven TM, Wouters MWJM, Grünhagen DJ, Verhoef C, van Houdt WJ. Isolated limb perfusion is an effective treatment modality for locally advanced Kaposi sarcoma of the extremities. Eur J Surg Oncol 2020; 46:1315-1319. [PMID: 32359920 DOI: 10.1016/j.ejso.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Kaposi sarcoma (KS) is a rare soft tissue sarcoma. In case of locally advanced disease, mutilating surgery such as amputations or major reconstructive procedures are sometimes inevitable. The aim of this study was to evaluate the effectiveness of isolated limb perfusion (ILP) in patients with locally advanced KS of the extremities. MATERIAL AND METHODS All patients who underwent ILP for KS between 1996 and 2018 at Erasmus MC, Rotterdam were identified. Clinical data was obtained from either a prospectively maintained database or retrospective assessment of patient files. RESULTS A total of 14 primary ILP's were performed in 11 patients. Median follow-up from primary ILP was 30 months (range, 5-98). The overall response rate of primary ILP was 100%, with a complete response (CR) rate of 50%. Only minimal local toxicity (Wieberdink I-III) was observed. Local progressive disease occurred after eight primary ILP's (57%) with a median local progression free survival (PFS) of 18 months (95% confidence interval [CI]: 7.0-28.9). Subsequently, four (46%) patients received a total of 5 recurrent ILP's. After the recurrent ILP on the same leg, the overall response rate was 75% and a CR-rate of 50%. One patient needed amputation post-operatively resulting in a limb salvage rate of 91%. One (9%) patient developed metastases four months after ILP. CONCLUSIONS ILP is a highly effective treatment modality with very limited morbidity rates for patients with locally advanced KS of the extremity. ILP should be considered as a treatment modality for locally advanced KS of the extremities.
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Affiliation(s)
- T Boere
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - E A Huis In 't Veld
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Surgical Oncology, Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - J P Deroose
- Department of Surgical Oncology, Erasmus MC - Cancer Institute, Rotterdam, the Netherlands; Department of Surgical Oncology, Martini Hospital, Groningen, the Netherlands
| | - T M van Ginhoven
- Department of Surgical Oncology, Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - M W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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Severely Disseminated Kaposi Sarcoma after ABO-Incompatible Kidney Transplantation Treated Successfully with Paclitaxel and Gemcitabine Combined with Hemodialysis. Case Rep Transplant 2019; 2019:8105649. [PMID: 31886011 PMCID: PMC6927053 DOI: 10.1155/2019/8105649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022] Open
Abstract
Kaposi Sarcoma (KS) is driven by human herpes virus 8 causing vascular proliferation which is induced by loss of immune function most often due to HIV or immunosuppressants. KS occurs with increased incidence in kidney transplant recipients, but rarely is disseminated. We report a 64-year-old male who developed severely disseminated KS 5 months after ABO-incompatible kidney-transplantation. No guidelines for chemotherapy exist in this case and reduced kidney function and impaired immune system complicates the use of systemic chemotherapy in kidney transplant recipients. A combination of paclitaxel and gemcitabine followed by two days of hemodialysis treatment was chosen since paclitaxel can be given in full dose independently of kidney function and gemcitabine is metabolised to 2′,2′-difluorodeoxyuridine which is found to be highly dialysable. The present treatment was well tolerated by the patient with one episode of leukopenia and elevated alanine transaminase during treatment which resolved. There were no serious adverse events and the patient obtained a complete remission verified by Positron Emission Tomography CT after ending chemotherapy and at one-year follow up.
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Bohelay G, Arzouk N, Lévy P, Rabaté C, Le Cleach L, Barete S, Barrou B, Matignon MB, Euvrard S, Lebbé C, Francès C. Outcome of second kidney transplantation in patients with previous post-transplantation Kaposi's sarcoma: A French retrospective study. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Gérôme Bohelay
- Department of Dermatology and Allergology; University Paris VI; Hôpital Tenon; Paris France
| | - Nadia Arzouk
- Department of Urology; University Paris VI; Hôpital Pitié Salpêtrière; Paris France
| | - Pierre Lévy
- Department of Public Health; Hôpital Tenon; APHP; University Paris VI; and Institut National de la Santé et de la Recherche Médicale; UMR-S 1136; Paris France
| | - Clémentine Rabaté
- Department of Nephrology; University Paris V; Hôpital Necker; Paris France
| | - Laurence Le Cleach
- Department of Dermatology; AP-HP; Hôpitaux Universitaires Henri Mondor; Créteil France
- EA EpiDermE; INSERM Créteil; Créteil France
| | - Stéphane Barete
- Department of Dermatology and Allergology; University Paris VI; Hôpital Tenon; Paris France
| | - Benoît Barrou
- Department of Urology; University Paris VI; Hôpital Pitié Salpêtrière; Paris France
| | - Marie-Benedicte Matignon
- Department of Nephrology and Transplantation; Assistance Publique-Hôpitaux de Paris; Groupe Henri Mondor-Albert Chenevier; Centre d'Investigation Clinique-BioThérapies 504; Institut National de la Santé et de la Recherche Médicale U955; Paris XII University; Créteil France
| | - Sylvie Euvrard
- Department of Dermatology; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
| | - Céleste Lebbé
- Department of Dermatology; APHP, University Paris VII; Hôpital Saint-Louis; Paris France
| | - Camille Francès
- Department of Dermatology and Allergology; University Paris VI; Hôpital Tenon; Paris France
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Brambilla L, Tourlaki A, Genovese G. Iatrogenic Kaposi's Sarcoma: a Retrospective Cohort Study in an Italian Tertiary Care Centre. Clin Oncol (R Coll Radiol) 2017; 29:e165-e171. [PMID: 28610760 DOI: 10.1016/j.clon.2017.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
AIMS Kaposi's sarcoma (KS) is a lymphoangioproliferative multicentric disorder. Among its four distinct clinical variants, iatrogenic KS (iKS) typically affects patients who have received immunosuppressant regimens for organ transplants, proliferative disorders, or immune-mediated diseases. The aim of the current study was to examine the characteristics of a cohort of patients with iKS, evaluating the differences in terms of epidemiological and clinical features, management and outcomes between organ transplant recipients (OTR) and patients immunosuppressed for other medical conditions. MATERIALS AND METHODS This retrospective study included, out of 1389 KS patients, 143 patients suffering from iKS being followed in an Italian tertiary care centre from November 1995 to December 2016. Demographic data, clinical features, previous immunosuppressive therapies, management, and outcomes were recorded for each patient. RESULTS We detected iKS in 10.3% of the analysed KS population. The mean age was 71.9 years in non-OTR versus 51.4 years in OTR (P = 0.04). Staging at diagnosis showed a more severe disease in non-OTR than in OTR, with stage IA observed in 33.3% of OTR versus 11.8% of non-OTR (P < 0.001) and stage IVB in 29.1% of non-OTR versus 12.1% of OTR (P = 0.001). Corticosteroids represented the most frequent immunosuppressive drugs at diagnosis in both groups, in conjunction with cyclosporine A in OTR. Immunosuppressant reduction or withdrawal was carried out in 93.9% of OTR versus 63.6% of non-OTR (P < 0.001). CONCLUSIONS As corticosteroids and cyclosporine A are the most common iKS-inducing drugs, their reduction or withdrawal, wherever possible, is needed. Differences in disease severity at presentation between OTR and non-OTR may interfere with the choice of management strategy and the consequent outcome.
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Affiliation(s)
- L Brambilla
- Unit of Dermatology, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Tourlaki
- Unit of Dermatology, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Genovese
- Unit of Dermatology, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Cancers solides après transplantation d’organe : épidémiologie, pronostic et spécificités de prise en charge. Bull Cancer 2017; 104:245-257. [DOI: 10.1016/j.bulcan.2016.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/22/2016] [Accepted: 12/30/2016] [Indexed: 12/20/2022]
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Gorsane I, Bacha MM, Abderrahim E, Amri N, Hajri M, Ounissi M, Harzallah A, El Younsi F, Hedri H, Ben Abdallah T. Post kidney transplantation Kaposi's sarcoma: the experience of a Mediterranean North African center. Clin Transplant 2016; 30:372-9. [DOI: 10.1111/ctr.12694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Imen Gorsane
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Mohamed Mongi Bacha
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Ezzedine Abderrahim
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Nadia Amri
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Malika Hajri
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Mondher Ounissi
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Amel Harzallah
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Fathi El Younsi
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Hafedh Hedri
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Taieb Ben Abdallah
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
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Borges-Costa J, Lopes L, Soares-Almeida L, Guerra J. Kaposi's sarcoma presenting as violaceous macules on the chest of a kidney transplanted patient. BMJ Case Rep 2016; 2016:bcr-2015-210999. [PMID: 26759393 DOI: 10.1136/bcr-2015-210999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Organ transplant recipients have a high incidence of cancer associated with persistent viral infections, such as human herpes virus 8. This virus is associated with Kaposi's sarcoma, and a change in the dose or type of immunosuppression regimen should be the first step in its treatment. A multidisciplinary approach with nephrologists, dermatologists and oncologists is necessary for the management of this disease. We report a clinical case with atypical presentation and discuss the treatment options.
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Affiliation(s)
- João Borges-Costa
- Unidade de Investigação em Dermatologia, Clínica Universitária de Dermatologia de Lisboa, Faculdade de Medicina da Universidade de Lisboa, CHLN, IMM, Lisboa, Portugal Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
| | | | - Luís Soares-Almeida
- Faculdade de Medicina da Universidade de Lisboa, CHLN, IMM, Unidade de Investigação em Dermatologia, Clínica Universitária de Dermatologia de Lisboa, Lisboa, Portugal
| | - José Guerra
- Unidade de Transplante, CHLN, Lisboa, Portugal
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Querido S, Sousa HS, Pereira TA, Birne R, Matias P, Jorge C, Weigert A, Adragão T, Bruges M, Machado D. Gastrointestinal Bleeding and Diffuse Skin Thickening as Kaposi Sarcoma Clinical Presentation. Case Rep Transplant 2015; 2015:424508. [PMID: 26783491 PMCID: PMC4689922 DOI: 10.1155/2015/424508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/12/2015] [Indexed: 02/06/2023] Open
Abstract
A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in April 2013. He received immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Immediate diuresis and a good allograft function were soon observed. Six months later, the serum creatinine level increased to 2.6 mg/dL. A renal allograft biopsy revealed interstitial fibrosis and tubular atrophy grade II. Toxicity of calcineurin inhibitor was assumed and, after a switch for everolimus, renal function improved. However, since March 2014, renal function progressively deteriorated. A second allograft biopsy showed no new lesions. Two months later, the patient was admitted due to anuria, haematochezia with anaemia, requiring 5 units of packed red blood cells, and diffuse skin thickening. Colonoscopy showed haemorrhagic patches in the colon and the rectum; histology diagnosis was Kaposi sarcoma (KS). A skin biopsy revealed cutaneous involvement of KS. Rapid clinical deterioration culminated in death in June 2014. This case is unusual as less than 20 cases of KS with gross gastrointestinal bleeding have been reported and only 6 cases had the referred bleeding originating in the lower gastrointestinal tract. So, KS should be considered in differential diagnosis of gastrointestinal bleeding in some kidney transplant patients.
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Affiliation(s)
- Sara Querido
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Avenida Xanana Gusmão, Apartado 45, 2350-754 Torres Novas, Portugal
| | - Henrique Silva Sousa
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Tiago Assis Pereira
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Rita Birne
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Patrícia Matias
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Cristina Jorge
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - André Weigert
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Teresa Adragão
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Margarida Bruges
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Domingos Machado
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
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Végső G, Tóth A, Toronyi É, Perner F, Máthé Z. Changes in Tumor Characteristics in Kidney Transplanted Patients Over the Last 40 Years. Transplant Proc 2015; 47:2198-200. [DOI: 10.1016/j.transproceed.2015.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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