Everolimus-induced lymphedema in a renal transplant recipient: a case report

Exp Clin Transplant. 2012 Jun;10(3):296-8. doi: 10.6002/ect.2011.0139.

Abstract

The mammalian target of rapamycin inhibitors is commonly preferred for solid organs for transplantation. Although these drugs have various adverse effects, sirolimus-related lymphedema has been rarely reported. We report a case of lymphedema related to everolimus after a kidney transplant. A 60-year-old woman successfully received a deceased-donor kidney. Everolimus was added to the treatment in postoperative month 3 owing to other immunosuppressive drugs' adverse effects. Edema occurred first on her feet in the first year after the transplant. During 3 months' follow-up, with no immunosuppressive adjustment, the edema progressed. Diagnosis of lymphedema was established. Several weeks after discontinuing everolimus, the patient's lymphedema began to resolve itself and completely disappeared in 3 months. The mammalian target of rapamycin inhibitors rarely causes lymphedema by inhibiting different subtypes of vascular endothelial growth factors, which results in impaired lymphangiogenesis. While there are few reports about sirolimus-related lymphedema, this case represents the first everolimus-related case of lymphedema. Further studies are warranted to explain the underlying mechanisms.

Publication types

  • Case Reports

MeSH terms

  • Everolimus
  • Female
  • Follow-Up Studies
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control*
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / immunology*
  • Lymphedema / chemically induced*
  • Lymphedema / diagnostic imaging
  • Lymphoscintigraphy
  • Middle Aged
  • Sirolimus / adverse effects
  • Sirolimus / analogs & derivatives*
  • Sirolimus / therapeutic use
  • Time Factors
  • Transplantation*
  • Treatment Outcome
  • Withholding Treatment

Substances

  • Immunosuppressive Agents
  • Everolimus
  • Sirolimus