Al-Otaibi T, Ahamed N, Nampoory M R N, Al-Kandari N, Nair P, Hallm M A, Said T, Samhan M, Al-Mousawi M
Hamed Al-Essa Organ Transplant Centre, Kuwait.
Transplant Proc. 2007 May;39(4):1207-10. doi: 10.1016/j.transproceed.2007.03.058.
Lymphedema is an increasingly observed complication of sirolimus (SIR) therapy. In this report, we describe four renal recipients with SIR-induced lymphedema of varying severity.
Patient 1, a 38-year-old man developed lymphedema of the left upper limb after being exposed to SIR for 30 months (mean daily Rapamune dose, 3 mg; trough level, 10-18 ng/mL). Venography and duplex ultrasound were normal. Lymphangiography was showed delayed lymphatic drainage. SIR was replaced with Prograf with significant improvement in the lymphedema over the next 6 months. Patient 2, a 26-year-old woman, developed lymphedema of the left lower limb at 24 months after starting SIR (mean daily dose, 3 mg; trough level, 10-15 ng/mL). Lymphangiography showed delayed drainage of lymphatics in the left lower limb. The patient was shifted to Prograf and there was some improvement over the next 4 months. Patient 3, a 28-year-old man, developed lymphedema of the left upper limb at 24 months after the start of SIR (mean daily dose, 2 mg, trough level, 6-15 ng/mL). Lymphangiography showed evidence of lymphatic obstruction. SIR was changed to cyclosporine with only mild improvement in lymphedema over the next 6 months. Patient 4, a 46-year-old man, developed lymphedema of the right upper limb at 7 months after starting SIR (mean daily dose, 6 mg; trough level, 10-16 ng/mL). Lymphangiography showed complete blockage of the lymphatic channels. SIR was changed to cyclosporine and there was mild improvement in lymphedema over the next 8 to 10 months.
The exact mechanism of SIR-induced lymphedema is unknown. The absence of other demonstrable etiologies and spontaneous improvement after discontinuation of SIR suggest that this drug was the responsible factor in these four patients. It occurred 7 to 30 months after transplantation. This is the fourth such report in the literature to the best of our knowledge.
淋巴水肿是西罗莫司（SIR）治疗中越来越常见的一种并发症。在本报告中，我们描述了4例接受肾脏移植的患者，他们因SIR治疗而出现了不同程度的淋巴水肿。
患者1，一名38岁男性，在接受SIR治疗30个月后（雷帕鸣平均每日剂量3毫克；谷浓度10 - 18纳克/毫升）出现左上肢淋巴水肿。静脉造影和双功超声检查结果正常。淋巴管造影显示淋巴引流延迟。将SIR换成普乐可复后，在接下来的6个月里淋巴水肿有显著改善。患者2，一名26岁女性，在开始使用SIR 24个月后（平均每日剂量3毫克；谷浓度10 - 15纳克/毫升）出现左下肢淋巴水肿。淋巴管造影显示左下肢淋巴管引流延迟。该患者改用普乐可复，在接下来的4个月里有一定改善。患者3，一名28岁男性，在开始使用SIR 24个月后（平均每日剂量2毫克，谷浓度6 - 15纳克/毫升）出现左上肢淋巴水肿。淋巴管造影显示有淋巴梗阻迹象。将SIR换成环孢素后，在接下来的6个月里淋巴水肿仅有轻微改善。患者4，一名46岁男性，在开始使用SIR 7个月后（平均每日剂量6毫克；谷浓度10 - 16纳克/毫升）出现右上肢淋巴水肿。淋巴管造影显示淋巴管完全堵塞。将SIR换成环孢素后，在接下来的8至10个月里淋巴水肿有轻微改善。
SIR引起淋巴水肿的确切机制尚不清楚。排除了其他可证实的病因，且停用SIR后症状自发改善，这表明在这4例患者中该药物是致病因素。淋巴水肿发生在移植后7至30个月。据我们所知，这是文献中第四例此类报告。
