Clinical features and course of Kaposi's sarcoma in Egyptian kidney transplant recipients

The prevalence of Kaposi's sarcoma (KS) after renal transplantation varies greatly depending on geographic and ethnic backgrounds. Out of 1400 live-donor kidney transplantation, 50 patients developed malignancy in our center. Kaposi's sarcoma was diagnosed in 24 patients (48%). Twenty patients were males and the main age of the patients was 29.8 +/- 11.1 years. They developed KS at a mean interval of 33.9 +/- 27.2 months, and the main duration of follow up was 62.2 +/- 50.7 months. Nineteen patients were cyclosporinee treated while four patients were azathioprine-based. Cutaneous KS was diagnosed in 20 patients, visceral in one, and three patients had both lesions. We found that the frequency of HLA-A1, -A2 and -DR5 were significantly common in KS patients. Titrated reduction of immunosuppression was initially tried in all patients. Bleomycin injection and superficial irradiation was tried in some cases. Response to therapeutic modalities was good in cutaneous form of KS. Twelve patients died (50%), two of them with functioning graft. We conclude that KS is the most common malignancy after kidney transplantation in our locality. Patients on cyclosporine are more prone to develop KS, and certain HLA-antigens may predispose to this. Early diagnosis and interference carry a favorable outcome.