肾移植术后并发Kaposi肉瘤一例及文献复习

Kaposi sarcoma after kidney transplantation: a case report and literature review

目的通过对1例肾移植术后并发Kaposi肉瘤受者的诊治,探讨肾移植术后并发Kaposi肉瘤的流行病学、临床特点、病因和治疗。方法回顾性分析1例肾移植术后并发Kaposi肉瘤受者的临床资料并复习国内外相关文献。受者系老年男性,因终末期尿毒症接受同种异体肾移植术,手术顺利,术前行EB病毒等抗体检测皆为阴性,供肾者为公民逝世后器官捐献(心脏死亡器官捐献)。该受者于肾移植术后3个月余时,右小腿外侧开始出现暗褐色斑块,左耳处出现一类圆形紫色肿物,逐渐增大,未伴有其他特殊不适。入院后给予相关检查示移植肾功能稳定,未发现其他相关病灶存在,行人类免疫缺陷病毒(HIV)抗体确认实验为阴性,病理检查符合Kaposi肉瘤,遂诊断为:Kaposi肉瘤,肾移植状态。结果明确病情后,停用环孢素A+吗替麦考酚酯+泼尼松三联免疫抑制方案,将免疫抑制药物改为西罗莫司,血药浓度维持在5.69 μg/L左右。经过半年时间治疗后,该受者的Kaposi肉瘤逐渐消失,并且移植肾功能稳定,随访至今,未见肿瘤的复发。结论对于肾移植相关型Kaposi肉瘤,皮肤损害特点有助于诊断,确诊依靠病理,将免疫抑制药物改为西罗莫司或许是一个不错的治疗选择。

Objective To investigate the epidemiology, clinical features, etiology and treatment of Kaposi sarcoma after kidney transplantation through the diagnosis and treatment of a patient with Kaposi sarcoma after kidney transplantation. Methods The clinical data of a 61-year-old man with Kaposi sarcoma who had kidney transplantation in 2015 were retrospectively analyzed, and the relevant leteratures at home and abroad were reviewed. The patient was an elderly male who underwent renal allograft transplantation for end-stage uremia, and the operation was successful. Preoperative detection of antibodies such as EB virus were negative. Besides, the donor donated organs after the death of the citizen (donation after cardiac death). The man developed dark brown plaques on the outside of his right lower leg and had a roundish-purple tumor on his left ear at the end of 3 months after kidney transplantation, gradually increasing without any other special discomfort. After admission, relevant examinations showed that the function of the transplanted kidney was stable and no other related lesions were found. HIV confirmatory test was negative and the pathology was consistent with Kaposi sarcoma. Therefore, the diagnosis was Kaposi sarcoma and kidney transplantation status. Results Then, the treatment was modified. The cyclosporine + mycophenolate mofetil + prednisone triple immunosuppressive regimen was discontinued and the immunosuppressive drug was changed to sirolimus at a concentration of about 5.69 ng/mL. After treatment for half a year, the Kaposi sarcoma disappeared gradually. Furthermore, the graft function was still stable and up to now, no recurrence of Kaposi sarcoma has been observed. Conclusion Though characteristics of skin lesion are helpful, confirmed diagnosis relies on pathology. And sirolimus may be effective in the treatment of Kaposi sarcoma after kidney transplantation.