신장이식 후 발생한 Kaposi 육종

Abstract

Purpose: Although renal transplantation is the most effective treatment for end stage renal disease (ESRD), the incidence of malignant tumors due to long-term immunosuppression has been increasing. We experienced 9 cases of Kaposi’s sarcoma (KS) after renal transplantation in our institution out of 2250 renal transplant recipients. KS is a rare mesenchymal tumor involving blood and lymphatic vessels. The oncogenesis by human herpesvirus 8 (HHV8) represent important condition for this tumor to develop.

Methods: Clinicopathologic features, treatment results, and prognosis of the 9 patients diagnosed with KS after renal transplantation were analyzed retrospectively.

Results: There were 6 male and 3 female patients. The mean age was 41.1 years. The average period until diagnosis of KS after renal transplantation was 60 months (range: 6 months~8 years). Clinical features were variable, but mostly presenting several red- purple papular and nodular tumors. Lesions were found in the lower extremities in 6 patients. Three patients presented with palpable lymph nodes in the neck and inguinal area without any skin lesions. Computed tomography showed diffusely enlarged showed an aggressive course. lymphnodes. Systemic involvement was found in 2 patients.Diagnosis was confirmed by histopathologic studies. Immunohistochemical stains for HHV8 were positive in all patients. Five patients showed regression of lesions after drastic reduction of immunosuppression, local resection and/or radiotherapy. But other 4 patients resistant to therapy.

Conclusion: KS is a rare tumor and appears to be caused primarily by HHV8 in Korea as well. Reduction or cessation of immunosuppression potentially improves symptoms, but it also increases the risk of chronic graft rejection or graft failure. A large-scale study, accumulating data from transplantation cases in Korea, to understand the relationship between the various types of immunosuppression and KS, and to set guidelines for treatment appears to be necessary in the future.