Mohsin N, Budruddin M, Pakkyara A, Darweesh A, Nayyer M, Amitabh J, Daar A S
Department of Nephrology, Royal Hospital, Muscat, Oman.
Exp Clin Transplant. 2005 Dec;3(2):366-9.
The prevalence of Kaposi's sarcoma (KS) is much greater in organ transplant recipients than it is in the general population. Its etiology appears to be related to geographic, genetic, and viral factors. Treatment of transplant-related KS has, until now, consisted mainly of reduction of, or withholding of, immunosuppression, often with deleterious effects on both graft and patient survival. In recent years, the immunosuppressive drug, sirolimus, has been demonstrated as possessing anti-neoplastic properties in both in vitro and animal models. In view of these properties and some preliminary clinical experience, we postulated that sirolimus would be beneficial in our patients who developed transplant-related KS. Here, we report the first case of a patient with both cutaneous and visceral KS who was successfully treated in the Middle East by conversion from a cyclosporine-based to a sirolimus-based immunosuppression regimen. The KS regressed completely within a few months after the conversion. The chronologic events and the extensive documentation, which included repeat computed tomography scans, are very suggestive of a selective anti-neoplastic effect of sirolimus.
卡波西肉瘤（KS）在器官移植受者中的患病率远高于普通人群。其病因似乎与地理、遗传和病毒因素有关。迄今为止，移植相关KS的治疗主要包括减少或停用免疫抑制，这通常对移植物和患者存活都有有害影响。近年来，免疫抑制药物西罗莫司已在体外和动物模型中被证明具有抗肿瘤特性。鉴于这些特性和一些初步临床经验，我们推测西罗莫司对我们发生移植相关KS的患者有益。在此，我们报告中东地区首例皮肤和内脏均患KS的患者，通过将基于环孢素的免疫抑制方案转换为基于西罗莫司的方案而成功治疗。转换后几个月内，KS完全消退。包括重复计算机断层扫描在内的按时间顺序记录的事件和详尽记录非常提示西罗莫司具有选择性抗肿瘤作用。
