Outcome of second kidney transplantation in patients with previous post‐transplantation Kaposi's sarcoma: A French retrospective study

Abstract

This retrospective study concerned 8 patients with post-transplantation Kaposi's sarcoma (pt-KS) after a first kidney transplant who later had a second kidney transplantation. Pt-KS was widespread, with lymph node or visceral involvement in 7 cases. Complete remission was observed in 6 cases and partial remission in 2. After the second kidney transplantation, only 2 cases showed recurrence of skin KS, one with previous complete remission of KS and one with partial remission. The mean delay between stability or complete remission of KS and retransplantation was 2.0 and 7.3 years in patients with and without relapse, respectively. Both recurrent cases showed complete KS remission after tapering immunosuppression therapy and/or switching a calcineurin inhibitor to a mammalian target of rapamycin inhibitor. We compared these 8 cases to 24 controls who had undergone 2 kidney transplantations but did not have KS, matching on sex, age and phototype. Cases and controls did not differ in graft function or survival. A second kidney transplantation may be possible after pt-KS and has acceptable risk, especially after a long complete remission of pt-KS.

Kaposi’s sarcoma regression after long term treatment of m-TOR inhibitors and cancellation of immunosuppressive therapy in patient after kidney transplantation

“…В данном наблюдении достигнут некоторый эффект от конверсии с ингибиторов кальциневрина на ингибиторы m-TOR (сиролимус, эверолимус), этот же феномен описан для уменьшения риска развития раковых опухолей кожных локализаций [6]. Определенный оптимизм вселяют исследования о возможности повторных трансплантаций почки у таких пациентов [7,8]. Показано, что риск возникновения рецидива СК после повторных трансплантаций невысок в случае достижения устойчивой ремиссии в период отсутствия трансплантата.…”

Assessment of kidney transplant suitability for patients with prior cancers: is it time for a rethink?

“…In patients who have developed de novo cancers during prior kidney transplants, the clinical decision regarding medical suitability and duration of cancer waiting time when considering repeat transplantation should be similar to the current recommendations of those with a history of cancers prior to the initial transplantation. For certain transplant‐specific cancers such as Kaposi's sarcoma and PTLD, successful repeat transplantation has been consistently reported although reports of cancer recurrence (for both Kaposi's sarcoma and PTLD) have been infrequently reported . However, the timing of repeat transplantation, the optimal immunosuppressive regimen (or whether to consider using mTOR inhibitor as initial immunosuppression) or whether certain prior cancer‐specific characteristics (e.g.…”