RENAL-TRANSPLANTATION EXPOSES PATIENTS WITH PREVIOUS KAPOSIS-SARCOMA TO A HIGH-RISK OF RECURRENCE

It is currently estimated that about 0.5% of patients will develop Kap osi's sarcoma (KS) after kidney transplantation. Tapering of immunosup pression often leads to KS remission, but also results in graft loss i n more than 50% of cases. Whether retransplantation is safe in these p atients is unknown. We here report on eight patients who developed KS recurrence after kidney transplantation-(A) Patients with previously t reated KS: There were 4 patients who had clinical remission of KS (inc luding three posttransplantation) for periods ranging from 5 months up to 19 years before transplantation. All 4 developed KS recurrence wit hin months after transplantation. In 3 patients, KS regressed only whe n all immunosuppression was discontinued, at the price of allograft re moval. Partial remission occurred in the fourth patient following redu ction of immunosuppression and gancyclovir administration; (B) Patient s with recurrent KS during a single transplant: 4 patients developed K S after transplantation that regressed following reduction of immunosu ppressive therapy. Increased immunosuppression, in the form of steroid pulses in 3 patients was associated with recurrence of KS. Subsequent reduction of immunosuppression caused regression of KS in all 4 patie nts, but 2 recipients lost their allografts. These data emphasize the high risk of recurrence of KS after renal transplantation. If physicia ns decide to transplant patients with a history of KS, they should inf orm the future recipient of the possibility of KS recurrence.