KAPOSIS-SARCOMA AFTER RENAL-TRANSPLANTATION IN TURKEY

In this report, incidence and clinical characteristics of Kaposi's sar coma (KS) were retrospectively analyzed among renal transplant recipie nts who were being followed-up in the outpatient clinic of the Istanbu l School of Medicine. Between October 1983 and December 1997, 17 cases of KS were diagnosed among 557 patients (3%). Of the total 25 post-tr ansplant malignancies, KS was the most common tumor, representing a ra te of 68%. Diagnosis was suspected with typical skin lesions and was c onfirmed by biopsy. Gastroduodenal endoscopy was applied to 7 patients in order to assess gastrointestinal tract involvement. Of the total n umber of patients diagnosed with KS 14 were male and 3 female, with th e mean age of 40 +/- 15 (range 13-68) yr. The mean duration between th e date of transplantation and diagnosis of KS was 15.9 +/- 20.3 (range 1-65) months. The lesions were limited to the skin in 13 patients, wh ile skin and gastrointestinal tract were involved in 2 patients and ge neralized disease was noted in 2 patients. The initial therapeutic app roach was to withdraw cyclosporine and to reduce azathioprine. In the case of progression of the lesions azathioprine was also stopped. Besi des, surgical excision of the lesions, radiotherapy and/or chemotherap y were performed according to the clinical picture. Remission was obse rved in 14 patients after this therapy protocol. The 2 patients with g astrointestinal involvement and 1 patient with generalized KS died in spite of the above-mentioned therapeutic interventions. One of the pat ients on remission died of pneumonia. It was concluded that KS carried a high risk of morbidity and mortality in renal transplant recipients , and tapering of immunosuppression, especially withdrawal of cyclospo rine, affected the prognosis favorably.