Lymphoedema is an increasingly observed complication of siroloimus (SIR) therapy. In this report we describe four renal recipients with SIR induced lymphoedema of varying severity.
Patient 1: 38 year old male developed lymphoedema of the left upper limb after having being exposed to SIR for 30 months (mean daily rapamune dose was 3mg, trough level ranging from 10-18). Venography and duplex ultrasound were normal. Lymphangiography was done which showed a delayed lymphatic drainage. SIR was replaced with prograf and there was a significant improvement in the lymphoedoema over the next six months. 34 year old male developed lymphoedema of the left lower limb after 30 months after starting SIR (mean daily dose 3mg, trough level ranging from 10–15). Lymphangiography showed a delayed drainage of the lymphatic of the left lower limb. Patient was shifted to prograf from SIR and there was some improvement in the lymohoedema over the next 4 months. 28 year old male developed lymphoedema of the left upper limb 24 months after the start of SIR (mean daily dose 2mg, trough level 6-15). Lymphangiography showed evidence of lymphatic obstruction. SIR was changed to Cyclosporine and there was only mild improvement in lymphoedema over the next 6 months. 46 year old male developed lymphoedema of the right upper limb seven months after starting SIR (mean daily dose 6 mg and trough level ranging from 10–16). Lymphangiography showed complete blockage of the lymphatic channels. SIR was changed to cyclosporine and there was mild improvement in lymphoedema over the next 8 to 10 months. The exact mechanism of SIR induced lymphoedema is still not known. Absence of other demonstrable etiologies and its spontaneous improvement after discontinuation of SIR proves that this drug is the responsible factor in these four patients. It occurred 7-30 months after transplantation. This is probably the fourth such report in the literature to the best of our knowledge.