Kaposi's sarcoma in renal transplant patients: Predisposing factors and prognosis
Kaposi's sarcoma in renal transplant patients: Predisposing factors and prognosis
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DOI：
10.1016/j.transproceed.2004.12.034
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发表时间：
2005-03-01
影响因子：
0.9
通讯作者：
Titiz, MI
中科院分区：
文献类型：
--
作者：
Berber, I;Altaca, G;Titiz, MI
在两个中心的772例肾移植受者中，25例患者发生卡波西肉瘤（KS）（3.2%）。将25例定期随访记录的22例受者与另一组22例肾移植受者的易感因素进行比较。所有患者均接受环孢素（CsA）、硫唑嘌呤或吗替麦考酚酯和类固醇;接受尸体供体器官的患者还接受了抗淋巴细胞球蛋白诱导。KS在移植后平均25.8个月被诊断出来。男女比例;平均年龄;平均随访期;两组的B型肝炎、C型肝炎、巨细胞病毒状态和其他感染率相似。部分HLA-DR抗原仅见于KS患者。所有患者均有皮肤粘膜受累，其中54.5%为多发性。7例患者检测到内脏受累和淋巴结受累或两者兼而有之。一线治疗是停用CsA并减少其他药物的剂量。3例患者接受了额外的手术切除。14例（63.6%）患者完全缓解，其中6例在一线治疗不完全或缺乏反应后需要额外的化疗或放疗。2例患者因全身性KS而死亡，移植物功能正常。7例患者在诊断KS后平均36个月恢复血液透析。除HLA-DR抗原阳性率外，未发现其他明显的易感因素。对于多发性、弥漫性和快速进展性病变或器官功能障碍的患者，除了停用CsA和逐渐减少其他药物外，还应开始化疗或放疗。全身性KS预后最差。
Among 772 kidney transplant recipients in two centers 25 patients developed Kaposi's sarcoma (KS) (3.2 %). The twenty-two of 25 recipients with regular follow-up records were compared for predisposing factors with another group of 22 renal transplant recipients. All patients received cyclosporine (CsA), azathioprine, or mycophenolate mofetil and steroids; patients who received cadaver donor organs additionally received antilymphocyte globulin for induction. KS was diagnosed at a mean of 25.8 months after transplantation. The male to female ratio; mean age; mean follow-up period; hepatitis B, hepatitis C, cytomegalovirus status; and other infection rates were similar in the two groups. Some HLA-DR antigens were detected only in patients with KS. All patients had mucocutaneous involvement, which was multiple in 54.5 %. Visceral involvement, and lymph node involvement, or both was detected in seven patients. First-line treatment was to stop CsA and reduce the doses of the other drugs. Three patients underwent additional surgical excision. Fourteen (63.6 %) patients experienced complete remissions, including six who required additional chemotherapy or radiotherapy after incomplete or lack of responses to first-line treatment. Two patients died with functioning grafts due to generalized KS. Seven patients returned to hemodialysis at a mean of 36 months after the diagnosis of KS. No significant predisposing factor was observed other than the prevalence of specific HLA-DR antigens. Chemotherapy or radiotherapy should be initiated for patients with multiple, diffuse, and rapidly progressive lesions or organ dysfunction in addition to withdrawal of CsA and tapering of other drugs. Generalized KS displays the poorest prognosis.