Ersoy Alparslan, Koca Nizameddin
Department of Nephrology and Rheumatology, Uludag University, Medical School, Bursa, Turkey.
Exp Clin Transplant. 2012 Jun;10(3):296-8. doi: 10.6002/ect.2011.0139.
The mammalian target of rapamycin inhibitors is commonly preferred for solid organs for transplantation. Although these drugs have various adverse effects, sirolimus-related lymphedema has been rarely reported. We report a case of lymphedema related to everolimus after a kidney transplant. A 60-year-old woman successfully received a deceased-donor kidney. Everolimus was added to the treatment in postoperative month 3 owing to other immunosuppressive drugs' adverse effects. Edema occurred first on her feet in the first year after the transplant. During 3 months' follow-up, with no immunosuppressive adjustment, the edema progressed. Diagnosis of lymphedema was established. Several weeks after discontinuing everolimus, the patient's lymphedema began to resolve itself and completely disappeared in 3 months. The mammalian target of rapamycin inhibitors rarely causes lymphedema by inhibiting different subtypes of vascular endothelial growth factors, which results in impaired lymphangiogenesis. While there are few reports about sirolimus-related lymphedema, this case represents the first everolimus-related case of lymphedema. Further studies are warranted to explain the underlying mechanisms.
雷帕霉素靶蛋白抑制剂通常是实体器官移植的首选药物。尽管这些药物有各种不良反应，但西罗莫司相关的淋巴水肿却鲜有报道。我们报告一例肾移植后与依维莫司相关的淋巴水肿病例。一名60岁女性成功接受了来自已故供体的肾脏移植。由于其他免疫抑制药物的不良反应，术后第3个月开始加用依维莫司进行治疗。移植后第一年，患者首先出现足部水肿。在3个月的随访期间，未调整免疫抑制治疗，水肿进展。淋巴水肿诊断成立。停用依维莫司数周后，患者的淋巴水肿开始自行消退，并在3个月内完全消失。雷帕霉素靶蛋白抑制剂通过抑制血管内皮生长因子的不同亚型导致淋巴管生成受损，很少引起淋巴水肿。虽然关于西罗莫司相关淋巴水肿的报道很少，但该病例是首例与依维莫司相关的淋巴水肿病例。有必要进行进一步研究以解释其潜在机制。
