A rare cause of lower limb swelling in a kidney transplant recipient: Sirolimus

Gulsah Sasak1

1 Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Nephrology, Kadikoy,

Istanbul

Corresponding author:

Gulsah Sasak, MD Address: Istanbul Medeniyet University, Goztepe Training and Research Hospital,

Department of Nephrology, Kadikoy, Istanbul

Email: gulsahsasak@yahoo.com Phone: +905337177109

Key words: edema, lower limb, sirolimus

Word count: 253

Disclosure: The author has declared no competing interest.

Thirty year old man had kidney transplantation from living donor in 2010. His transplant

kidney was on his left iliac fossa. He was on tacrolimus, mycofenolat mofetil, prednizolon,

diltiazem and doxazosin. At post-transplant 1 year, kidney biopsy results was consistent with

calsineurin inhibitor toxicity. His immunosuppressive medication changed from tacrolimus to

sirolimus. In 2015, his right leg was swollen. He refused any recent trauma and no femoral

catheter was inserted. On physical examination; pulses were positive, there was no pain and

redness. Serum blood level of sirolimus was 5 ng/ml. Doppler ultrasound was normal. Due

to technical insufficiencies of our hospitals, we could not perform lymphoscintigraphy,

Diltiazem was stopped but there was not any improvement. Then sirolimus was rechanged to

tacrolimus. After that edema resolved within about 1 month. (figure 1),

After kidney transplantation, lower extremity edema can be seen from various causes; e.g

delayed graft dysfunction, drug (calcium channel blockers), deep venous thrombosis,

lymphocele. Also mammalian target of rapamycine inhibitor can cause edema to inhibit

lymphangiogenesis decreasing lympovasculer endothelial growth factor producing (1-2). In

the area of increasing use of mammalian target of rapamycine inhibitr, nephrologists must be

aware of this rare side effect to improve the quality of life of patients and to treat them

effectively.

Disclosure: The author has declared no competing interest.

Informed consent was obtained from the patient in whom in presented here.

Local ethic committee was approved to present this case report.(2017/0090)

References:

1- Thanaraj V, Woywodt A and Anderton J. A transplant patient with a swollen leg. Clin

Kidney J 2012;5:46770,

2- Kreuger J, Nilsson I, Kerjaschki D et al. Early lymph vessel development from

embryonic stem cells. Arterioscler Thromb Vasc Biol 2006; 26:107378.