Background: Kaposi Sarcoma (KS) is a malignancy that commonly appears as lesions on the skin or mucosal surfaces but can also develop in other organs. This cancer is usually caused by the human herpesvirus-8 (HHV-8), recently known as Kaposi’s sarcoma–associated herpesvirus (KSHV). KS is rare in the general population but can develop in renal transplant recipients with varying incidence due to immunocompromised status from immunosuppression. Objective: The main aim of the present systematic review was to identify the prevalence and treatment of KS in renal transplant patients. Design and Methodology PubMed, Cochrane Library, and Google Scholar databases were searched for studies until October 2023. Full-text studies with similar research objective were included, while non-English articles, reviews, case reports, ongoing clinical trials, and studies evaluating KS in HIV patients or after other solid organ transplants were excluded. All studies were non-randomized; therefore, methodological quality was assessed using the Newcastle-Ottawa Scale. The statistical analyses were performed with the Comprehensive Meta-Analysis software. Results: The pooled analysis from the 15 studies (included) showed that KS develops in 1.5% of kidney transplant recipients and is more prevalent in African (1.7%) and Arabic (1.7%) recipients than in Western recipients (0.07%). KS was also significantly more prevalent among male recipients than female recipients (OR: 2.36; P<.0001). Additionally, Cyclosporine-based immunosuppression accounts for most KS incidences (79.6%) compared to Azathioprine-based immunosuppression (28.2%). Furthermore, reduction or withdrawal of immunosuppression alone resulted in 47.8% KS complete remissions. Discussion and conclusions: Post-renal transplantation KS is more frequent among males and patients of Arabic and African origin. We believe that if gender balance is considered in future studies, then the difference might be insignificant. Based on our results, we can concur that the mainstay treatment for post-transplant KS is reduction or withdrawal of immunosuppression. However, patients should be closely monitored to avoid KS recurrence and kidney rejection. Cyclosporine-based immunosuppression increases the risk of KS, but withdrawal of azathioprine with or without cyclosporine reduction is also associated with improved outcomes.
CLO24-067: FIGURE 1. Kaposi sarcoma prevalence according to the region.
The subgroup analysis shows that patients of African and Arabic origin have higher incidences of KS than those of Western Origin.
Citation: Journal of the National Comprehensive Cancer Network 22, 2.5; 10.6004/jnccn.2023.7268
CLO24-067: FIGURE 2. Kaposi sarcoma prevalence in male versus female recipients.
A head-to-head comparison of KS incidence according to gender shows that male kidney transplant recipients are more likely to develop KS than female recipients.
Citation: Journal of the National Comprehensive Cancer Network 22, 2.5; 10.6004/jnccn.2023.7268
CLO24-067: FIGURE 3. Incidence of Kaposi Sarcoma in patients receiving cyclosporine-based immunosuppression.
Cyclosporine-based immunosuppression is associated with a high incidence of KS (79.6%) after kidney transplantation.
Citation: Journal of the National Comprehensive Cancer Network 22, 2.5; 10.6004/jnccn.2023.7268
CLO24-067: FIGURE 4. Incidence of Kaposi sarcoma in patients receiving azathioprine-based immunosuppression.
Azathioprine-based immunosuppression without cyclosporine is associated with a low KS prevalence (28.2%) in kidney transplant patients.
Citation: Journal of the National Comprehensive Cancer Network 22, 2.5; 10.6004/jnccn.2023.7268
CLO24-067: FIGURE 5. Impact of immunosuppression reduction or withdrawal on complete remission.
Withdrawal or reduction in immunosuppression alone results in completion remission in 47.8% of patients with KS.
Citation: Journal of the National Comprehensive Cancer Network 22, 2.5; 10.6004/jnccn.2023.7268
