Kidney Week

Abstract: SA-PO949

A Case of Kaposi’s Sarcoma Developed during the Intensive Immunosuppression Therapy against T Cell-Mediated Rejection, but Resolved Rapidly after Adding mTOR Inhibitor

Session Information

• Fellows/Residents Case Reports: ESRD: HD, PD, Transplant
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Nephrology Education

• 1302 Fellows and Residents Case Reports

Authors

• Sako, Kosuke, Tokai University School of Medicine, Isehara, Japan

Kosuke Sako,

• Nakagawa, Yosuke, Tokai University School of Medicine, Isehara, Japan

Yosuke Nakagawa,

• Isozaki, Yudai, Tokai University School of Medicine, Isehara, Japan

Yudai Isozaki,

• Kawabata, Chiaki, Tokai University School of Medicine, Isehara, Japan

Chiaki Kawabata,

• Hamano, Naoto, Tokai University School of Medicine, Isehara, Japan

Naoto Hamano,

• Ishida, Hiroaki, Tokai University School of Medicine, Isehara, Japan

Hiroaki Ishida,

• Koizumi, Masahiro, Tokai University School of Medicine, Isehara, Japan

Masahiro Koizumi,

• Ogura, Go, Tokai University School of Medicine, Isehara, Japan

Go Ogura,

• Wada, Takehiko, Tokai University School of Medicine, Isehara, Japan

Takehiko Wada,

• Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Japan

Masafumi Fukagawa,

• Nakamura, Michio, Tokai University School of Medicine, Isehara, Japan

Michio Nakamura,

Background

Incident renal allograft rejections have been decreasing in number due to dramatic advance in immunosuppression therapies for kidney transplantation (KT). In contrast, infections and de novo neoplasms associated with those therapies have become an important issue. Here, we report a case of Kaposi's sarcoma developed during the intensive immunosuppression therapy against T cell-mediated rejection, but resolved rapidly after adding mTOR inhibitor, everolimus.

Methods

A 44-year old Mongolian woman, who had been on hemodialysis for 4 years with end stage renal disease due to autosomal dominant polycystic kidney disease, received a kidney transplant from her husband. Because of ABO-incompatible KT, she had received rituximab 100 mg twice, double filtration plasmapheresis and intravenous immunoglobulin as pre-transplantation conditioning. Initial immunosuppression consisted of tacrolimus, mycophenolate mofetil, basiliximab and steroids. Her serum creatinine level was decreased to 1.26 mg/dL at minimum, however, it was elevated to 1.69 mg/dL again at 2 months after KT. The findings of a graft biopsy were compatible with T cell-mediated rejection, which was successfully treated with steroid pulse therapy and gusperimus hydrochloride. Immunosuppression therapy was intensified by increasing the dose of tacrolimus and her serum creatinine levels persisted 1.6-1.8 mg/dL thereafter. However, there appeared aggregated dark reddish nodules on her skin at nose and between eyebrows at 6 months after KT. They did not resolve with topical corticosteroid and tacrolimus but rather grew gradually. Skin biopsy demonstrated monomorphic spindled cells with HHV-8-positive nuclei and capillary proliferation, which provided the diagnosis of Kaposi’s sarcoma. Everolimus was added to immunosuppression therapy regimen and then the sarcoma was significantly reduced.

Conclusion

Kidney transplant patients with Kaposi’s sarcoma are supposed to increase in number with the progress of immunosuppression therapies. Everolimus, which is expected to have an anti-angiogenic effect, may be one of therapeutic options for Kaposi’s sarcoma associated with immunosuppression therapies.