Zmonarski Sławomir C, Boratyńska Maria, Puziewicz-Zmonarska Anna, Kazimierczak Krzysztof, Klinger Marian
Departament of Nephrology and Transplantation Medicine, Wrocław Medical University, Poland.
Ann Transplant. 2005;10(2):59-65.
Kaposi's sarcoma (KS) is a spindle-shaped vascular cell tumor that occurs in the skin, lymphoid, respiratory and gastrointestinal tissues. It may resemble aggressive malignant neoplasm in HIV-related or in post-transplant types but classic form may behave as benign, potentially controllable and reversible hyperplasia. KS lesions from the onset are dispersed and multicentric. KS probability increases in solid organ transplant recipients (approximately 3/1000 patients). KS occurrence is associated with: type and dose of immunosuppression, chronic stimulation by foreign allograft antigens, viral infections (Herpes virus 8), anti rejection and induction therapy, etc. 90% of KS cases appear as dark blue or purplish macular lesions that may form nodular tumors. Histological picture shows networks of spindle shaped cells and vascular spaces surrounded by an endothelial cell layer. There is no uniform schema of KS treatment in renal transplant recipients. Immunosuppression must be reduced to the lowest levels which preserve allograft function. CsA should be converted to mofetil mycophenolate or mTOR-inhibitors. After conversion to MMF regression of KS was observed, although low therapeutic MMF doses seem to be appropriate. Sirolimus seems to inhibit the growth of established vascularized tumors and this effect is best realized with relatively low immunosuppressive doses of drug.
卡波西肉瘤（KS）是一种梭形血管细胞瘤，发生于皮肤、淋巴、呼吸和胃肠道组织。在与HIV相关的类型或移植后类型中，它可能类似于侵袭性恶性肿瘤，但经典型可能表现为良性、潜在可控且可逆的增生。KS病变从一开始就是分散的且多中心的。实体器官移植受者患KS的概率增加（约为3/1000患者）。KS的发生与以下因素有关：免疫抑制的类型和剂量、外来同种异体移植抗原的慢性刺激、病毒感染（疱疹病毒8型）、抗排斥和诱导治疗等。90%的KS病例表现为深蓝色或紫色斑疹病变，可能形成结节状肿瘤。组织学表现为梭形细胞网络和被内皮细胞层包围的血管间隙。肾移植受者中KS的治疗尚无统一方案。免疫抑制必须降至维持同种异体移植功能的最低水平。环孢素A应转换为霉酚酸酯或mTOR抑制剂。转换为霉酚酸酯后观察到KS消退，尽管似乎低治疗剂量的霉酚酸酯是合适的。西罗莫司似乎能抑制已形成的血管化肿瘤的生长，且在相对低剂量免疫抑制药物时这种效果最佳。
