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Sirolimus-associated lymphoedema: eight new cases and a proposed mechanism

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Sirolimus, an inhibitor of the mammalian target of rapamycin (mTOR), is increasingly used as an agent for post-transplant immunosuppression and the treatment of solid organ and haematological malignancies and hamartomas. Its advantages include a lack of nephrotoxicity and a lower incidence of nonmelanoma skin cancers; adverse effects include delayed wound healing, increased lymphocoele formation and rarely lymphoedema. We report a series of eight cases of severe, sustained, unilateral and bilateral lymphoedema in patients receiving sirolimus for post-transplant immunosuppression, classify their lymphoscintigraphy findings and propose a mechanism of aetiology based on the interaction of mTOR with key mediators of lymphangiogenesis.

Keywords: lymphoedema; mammalian target of rapamycin inhibitor; rapamycin; sirolimus; vascular endothelial growth factor C; vascular endothelial growth factor receptor 3

Document Type: Case Report

DOI: http://dx.doi.org/10.1111/j.1365-2133.2009.09098.x

Affiliations: Radiology, St George’s Hospital, Tooting, London SW17 0QT, U.K.

Publication date: June 1, 2009

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