Omid Zargari, a dermatologist from Rasht, Iran, is asking for your help regarding a 74 year old man with extensive Kaposi's sarcoma after renal transplantation. The disease began about two years ago, when he was on Cyclosporine (plus prednisolone). At that time, I asked the nephrologist to change CsA with Sirolimus. Now, he's on Pred+cellcept+sirolimus.I've seen several cases of post-transplant KS. All of them regressed after discontinuing CsA and haven't seen a case with such extent. HHV8 screening is not available here. I referred him to an oncologist, but he refused to start any chemotherapy because he believed this is not a life-threatening condition....considering the amount of impact the disease has put on the QOL of this gentleman, he is seeking for any help...at least a palliation.
What do you suggest?
Since degree of immunosuppression is the crucial factor, consider reducing cellcept and sirolimus to absolute lowest levels. Depending on the match, some patients can go off immunosuppression altogether for a period of time. I agree chemotherapy is difficult and unpredictable in KS.
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