Everolimus-induced Lymphedema in a Renal Transplant Recipient: A Case Report

Abstract

The mammalian target of rapamycin inhibitors is commonly preferred for solid organs for transplantation. Although these drugs have various adverse effects, sirolimus-related lymphedema has been rarely reported. We report a case of lymphedema related to everolimus after a kidney transplant. A 60-year-old woman successfully received a deceased-donor kidney. Everolimus was added to the treatment in postoperative month 3 owing to other immunosuppressive drugs' adverse effects. Edema occurred first on her feet in the first year after the transplant. During 3 months' follow-up, with no immunosuppressive adjustment, the edema progressed. Diagnosis of lymphedema was established. Several weeks after discontinuing everolimus, the patient's lymphedema began to resolve itself and completely disappeared in 3 months. The mammalian target of rapamycin inhibitors rarely causes lymphedema by inhibiting different subtypes of vascular endothelial growth factors, which results in impaired lymphangiogenesis. While there are few reports about sirolimus-related lymphedema, this case represents the first everolimus-related case of lymphedema. Further studies are warranted to explain the underlying mechanisms.

Systemic and Nonrenal Adverse Effects Occurring in Renal Transplant Patients Treated with mTOR Inhibitors

“…Lymphedema is a relatively rare adverse effect of mTOR-I therapy [99–102], but the underlying biological/physiological mechanism is not completely clarified. …”

Sirolimus-induced Inflammatory Lymphoedema of the Breast Resolved After Switching to Cyclosporine

“…About 15 other isolated cases have been published (3, 6, 7) mainly affecting the lower or upper limbs. These cases were generally unilateral (3), but occasionally bilateral (6,7). Moreover, a series of 5 patients with lymphoedema restricted to the breast was reported in 2012 (2).…”

Late-Onset Post-radiation Lymphedema Provoked by Bee Venom Therapy: A Case Report

“…Direct cytotoxicity to the weakened lymphatic circulation and inhibition of lymphangiogenesis due to VEGF down-regulation may have resulted in left leg lymphedema in this patient. Lymphedema induced by interference in the intracellular pathway of the lymphatic endothelial cells by reducing VEGF production was reported in a renal transplant recipient treated with everolimus medication [ 10 ].…”