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Sirolimus Anti-Tumour mTOR KS — ESENeph MCQ

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ModerateTransplantationSirolimus Anti-Tumour mTOR KSESENeph

A kidney transplant recipient develops Kaposi sarcoma (HHV-8 positive). After reducing immunosuppression, the lesions persist. His transplant team considers switching from Tacrolimus to Sirolimus. Why might Sirolimus help?

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Correct answer: C — Sirolimus (mTOR inhibitor) has anti-proliferative and anti-angiogenic properties that provide direct anti-tumour activity in addition to immunosuppression – conversion from CNI to mTOR inhibitor has shown regression of Kaposi sarcoma and some other post-transplant malignancies

mTOR inhibitors (Sirolimus, Everolimus) have dual immunosuppressive and anti-tumour properties. They inhibit the PI3K/Akt/mTOR pathway, which is critical for cell proliferation, angiogenesis, and tumour growth. In transplant recipients with Kaposi sarcoma, switching from CNI to Sirolimus has shown regression of KS lesions in multiple case series. KDIGO 2009 transplant guideline recommends considering mTOR inhibitor conversion for post-transplant malignancies. This approach maintains transplant immunosuppression while providing anti-tumour activity – a unique advantage of this drug class.

Reference: KDIGO 2009 – Transplant; Stallone et al 2005 – Sirolimus KS Regression