De Bartolomeis Carmine, Collini Andrea, Rumberger Brigitta, Barni Roberto, Ruggieri Giuliana, Bernini Marco, Carmellini Mario
UOC Chirurgia dei Trapianti-Azienda Ospedaliera Universitaria Senese, Siena, Italy.
Clin Transplant. 2008 Mar-Apr;22(2):254-7. doi: 10.1111/j.1399-0012.2007.00766.x.
Generalized lymphedema is an extremely rare effect of sirolimus therapy in renal transplant recipients. We describe the development of this complication in a 56-yr-old woman, who was given an experimental protocol with cyclosporine, sirolimus, steroids, and basiliximab. Following the protocol, after one month, the patient was randomized to the "sirolimus only" group, while cyclosporine was completely suspended and the oral steroids were continued. Three months later, the patient was admitted for severe lymphedema of the lower limbs, with significant weight increase, massive ascites and dyspnea, but excellent renal function. A chest radiography and an ultrasound study of the heart showed a moderate pleural and pericardial effusion. An abdominal ultrasound scan showed two small lymphoceles next to the transplanted kidney, confirmed with a CT scan. After sirolimus discontinuation the generalized lymphedema started to improve and three months later all the symptoms had disappeared.
全身性淋巴水肿是西罗莫司治疗肾移植受者极为罕见的一种不良反应。我们描述了一名56岁女性出现这种并发症的过程，该患者接受了包含环孢素、西罗莫司、类固醇和巴利昔单抗的实验方案。按照该方案，一个月后，患者被随机分配至“仅用西罗莫司”组，同时完全停用环孢素，继续口服类固醇。三个月后，患者因下肢严重淋巴水肿入院，体重显著增加，出现大量腹水和呼吸困难，但肾功能良好。胸部X线检查和心脏超声检查显示中度胸腔和心包积液。腹部超声扫描显示移植肾旁有两个小淋巴囊肿，CT扫描得以证实。停用西罗莫司后，全身性淋巴水肿开始改善，三个月后所有症状均消失。
