Generalized lymphedema in a sirolimus‐treated renal transplant patient

Bartolomeis, Carmine De; Collini, Andrea; Rumberger, Brigitta; Barni, Roberto; Ruggieri, Giuliana; Bernini, Marco; Carmellini, Mario

doi:10.1111/j.1399-0012.2007.00766.x

Cited by 20 publications

(18 citation statements)

References 11 publications

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“…Lymphedema, with or without ascites, pleural, and pericardial effusions have been reportedly improved by dosage lowering or discontinuing sirolimus in several renal transplant recipients. 2,5 Secondary lymphedema typically involves a single limb, while involvement that is more widespread may be seen in primary lymphedema. In our case, lymphedema began at the feet at the fifth month of everolimus therapy, and progressed to left upper limb and left breast within 3 months.…”

Section: Discussionmentioning

confidence: 99%

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

Koca¹

2012

Exp Clin Transplant

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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.

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Section: Discussionmentioning

confidence: 99%

“…Spontaneous formation of lymphedema has been seen with sirolimus-based immunosuppression in renal transplant recipients. [2][3][4][5] We report the first recipient who developed lymphedema 8 months after starting everolimus treatment.…”

Section: Introductionmentioning

confidence: 94%

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

Koca¹

2012

Exp Clin Transplant

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“…It is also thought to be effective in the prevention and treatment of graft-versus-host disease. De Bartolomeis et al (4) have reported a case where the patient received sirolimus immunosuppressive therapy following renal transplantation and had bilateral lower extremity edema, acid, and dyspnea complaints at postoperative month 3. In this case, the result of the sequential parasynthesis for exploring the tumoral and infectious cause was negative, and after discontinuation of sirolimus therapy, lymphedema was reversed completely.…”

Section: Discussionmentioning

confidence: 99%

“…Sirolimus is a macrolide-group antibiotic that is isolated from Streptomyces hygroscopicus (4). Its use in preventing acute rejection after renal transplantations and in chronic allograft nephropathia is becoming increasingly common.…”

Section: Discussionmentioning

confidence: 99%

Lymphedema Treatment in a Patient with a History of Intestinal Transplantation and Mesenchymal Stem Cell Transplantation

Donmez¹,

Kilinc²,

Doğan³

et al. 2015

Turk J Phys Med Rehab

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Lymphedema is a rare complication of sirolimus treatment in transplantation patients. We present a case of a 14-year-old female patient who developed lymphedema in three extremities. The patient had undergone ileal and colon resections after sustaining a gunshot to her abdomen. Four months after the injury, she had developed a short bowel syndrome and underwent small intestine transplantation from a cadaver and mesenchymal stem cell transplantation to prevent rejection. Because of kidney failure developed at postoperative month 3, mycophenolate mofetil therapy was discontinued and sirolimus therapy was initiated. The patient was monitored under this therapy until postoperative month 11 when she had swelling in both the legs and left arm. Her condition significantly improved with complex decongestive therapy. This is the first case in the literature involving mesenchymal stem cell transplantation together with ileum transplantation. This case is also noteworthy in terms of lymphedema treatment administered and the involvement of three extremities.

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“…13 Interestingly, all these reported sirolimus-related cases (including ours) were diagnosed after at least 3 months use of sirolimus. [14][15][16][17] Therefore, early use of sirolimus in our case should not be neglected as a possible cause of delayed-onset chylous ascites.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Chen

Chang²,

Lu³

et al. 2016

Exp Clin Transplant

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Chylous ascites is a rare complication in liver transplant. Few cases have been reported to date. In most cases, chylous ascites is diagnosed within 1 month after surgery because of intraoperative injury of the hilar lymphatic system. Preoperative massive ascites and use of a LigaSure vessel sealing system for hilar dissection have been reported as risk factors.We report a case of chylous ascites after a livingdonor liver transplant that was diagnosed after 6 months of uneventful follow-up. Sirolimus was added to cyclosporine early (2 wk after the operation) owing to poor renal function and it was found to be high (> 22 ng/mL) when the chylous ascites occurred. The patient was treated with total parenteral nutrition in combination with Sandostatin and rapid tapering of sirolimus after the failed initial conservative treatment. Residual abdominal fullness after meals and lymphedema of the legs disappeared 1 month after discontinuing sirolimus. This is the first case of delayedonset chylous ascites after a liver transplant that was successfully treated conservatively.

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Generalized lymphedema in a sirolimus‐treated renal transplant patient

Cited by 20 publications

References 11 publications

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

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

Lymphedema Treatment in a Patient with a History of Intestinal Transplantation and Mesenchymal Stem Cell Transplantation

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