Generalized lymphedema in a sirolimus‐treated renal transplant patient

• Published in: Clinical transplantation Vol. 22; no. 2; pp. 254 - 257
• Main Authors: De Bartolomeis, Carmine, Collini, Andrea, Rumberger, Brigitta, Barni, Roberto, Ruggieri, Giuliana, Bernini, Marco, Carmellini, Mario
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2008; Blackwell
• Subjects: Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the lymphatic vessels; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Hyperlipidemias - chemically induced; Immunosuppressive Agents - adverse effects; Kidney Failure, Chronic - surgery; Kidney Transplantation - adverse effects; Kidney Transplantation - methods; lymphedema; Lymphedema - etiology; Medical sciences; Middle Aged; Randomized Controlled Trials as Topic; renal transplant; sirolimus; Sirolimus - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Antineoplastic agent; Human; Sirolimus; Lactone; Cardiovascular disease; Patient; Transplantation; Homotransplantation; Macrolide; Generalized; Kidney; Macrocycle; Lymphatic vessel disease; Medicine; Antibiotic; Treatment; Urinary system; Lymphedema; Surgery; Graft; Protein synthesis inhibitor; Immunosuppressive agent; Antibacterial agent; rénal transplant
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2007.00766.x

:  Generalized lymphedema is an extremely rare effect of sirolimus therapy in renal transplant recipients. We describe the development of this complication in a 56‐yr‐old woman, who was given an experimental protocol with cyclosporine, sirolimus, steroids, and basiliximab. Following the protocol, after one month, the patient was randomized to the “sirolimus only” group, while cyclosporine was completely suspended and the oral steroids were continued. Three months later, the patient was admitted for severe lymphedema of the lower limbs, with significant weight increase, massive ascites and dyspnea, but excellent renal function. A chest radiography and an ultrasound study of the heart showed a moderate pleural and pericardial effusion. An abdominal ultrasound scan showed two small lymphoceles next to the transplanted kidney, confirmed with a CT scan. After sirolimus discontinuation the generalized lymphedema started to improve and three months later all the symptoms had disappeared.