Review: Male Kidney Transplant Recipients More Likely to Develop Kaposi Sarcoma

Findings presented at this month’s National Comprehensive Cancer Network (NCCN) annual conference show a significant gender disparity in who is likely to develop Kaposi sarcoma (KS) following a kidney transplant.¹

Male recipients were found to be more susceptible to this cancer, which is caused by human herpesvirus-8 (HHV-8) and can appear after patients receive immunosuppressive therapy to avoid rejecting the donor kidney.

KS is characterized by purple, red, and brown tumors or lesions that appear on the skin, often on the legs or face, which develop from cells that line lymph or blood vessels. Tumors can also appear elsewhere in the body, such as the lymph nodes, the lungs, or digestive tract.

An earlier version of the NCCN results appeared in Cureus; those findings also highlighted a greater likelihood of KS to appear among recipients of African or Middle Eastern descent.²

That article explained how KS emerges and its particular threat to patients receiving a new kidney. “The intricate link between the HHV-8 virus and the immune system has been articulated as the key mechanism in the genesis of KS, with the malignancy observed in immunosuppressed patients as a result of acquired immunodeficiency syndrome (AIDS) infection or organ transplants,” the authors wrote.

Sakditad Saowapa, MD | Image credit: Texas Tech

“A kidney transplant requires a delicate balance between immunosuppression to decrease the likelihood of graft rejection while controlling for increased susceptibility to viral infection at the same time,” they continued. Thus, KS incidence is “closely associated with the duration and intensity of immunosuppression among kidney transplant patients, especially in patients where HHV-8 serology is present pre-transplantation.”

The review, led by Sakditad Saowapa, MD, a current resident at Texas Tech University Health Sciences Center, captured 15 studies involving 323 patients diagnosed with KS, from the PubMed, Google Scholar, and Cochrane Library databases. The review found the following:

• The overall mean age of the patients was 42 years and the mean time to develop KS was 8 months after treatment.
• A head-to-head comparison by gender showed KS was more likely to develop in male kidney recipients than in female recipients (OR, 2.357; CI, 1.704-3.2260).
• Cyclosporine-based immunosuppression was associated with a higher likelihood of KS, with an event rate of 79.6% (95% CI, 70.4%-96.6%).
• Azathioprine-based immunosuppression—without cyclosporine—is associated with a low KS event rate, 28.2% (95% CI, 20.7%-37.2%).
• Withdrawal or reduction of immunosuppression prompts remission of KS in 47.8% (95% CI, 33.8-62.1%) of patients; however, this result did not reach statistical significance (P = .0763).

“These findings underscore the importance of personalized immunosuppressive strategies and close monitoring of kidney transplant patients for KS, particularly among high-risk groups, to mitigate the incidence and improve outcomes of KS in this vulnerable population,” the authors wrote in the NCCN abstract.

References

1. Saowapa S, Polpichai N, Siladech P, et al. Evaluating Kaposi sarcoma in kidney transplant patients: a systematic review and meta-analysis. Presented at: National Comprehensive Cancer Network Annual Meeting; April 5-7, 2024; Orlando, FL. Abstract JNCCN23-0592.
2. Saowapa S, Polpichai N, Siladech P, et al. Evaluating Kaposi sarcoma in kidney transplant patients: a systematic review and meta-analysis. Cureus. 2024;16(1):e52527.