tacrolimus and Paraproteinemias

Lymphoproliferative disorders (LPDs) are a serious side effect of immunosuppression after liver transplantation, and the introduction on the market of a new immunosuppressive drug has been associated with an increased risk of these disorders. To compare the effect of cyclosporine A (CSA) and FK506 in a clinical setting, the incidence of monoclonal or oligoclonal gammopathies known to often precede the appearance of LPDs was evaluated. A total of 88 adult patients was analyzed, 46 were prospectively randomized to CSA and 42 to FK506 for immunosuppression. None of these patients had gammopathy before transplantation. All the patients were tested for immunoglobulin abnormalities five to nine times during a period of 1 year and then two to four times per year thereafter from December 1990 until March 1997. The same incidence of serum immunoglobulin (Ig) abnormalities was observed in both groups (13%) with a mean delay of appearance of 11.1 +/- 5.9 versus 7.6 +/- 3.6 months for CSA and FK506, respectively (P > .05). In each group, the gammopathies were transient in 3 patients and persisted in 2. The class of Ig involved was IgG, and a monoclonal component was documented in 2 patients treated with CSA and in 3 patients with FK506. One patient treated with FK506 developed an LPD localized to the lymph nodes 8 months after the occurrence of serum protein abnormalities. The lymphoproliferative lesions subsequently disappeared with the reduction of immunosuppression. In this study, an immunosuppressive regimen of FK506 has not shown an increased incidence of lymphoproliferation compared with CSA in adult liver transplant patients.

Topics: Adrenal Cortex Hormones; Adult; Azathioprine; Cyclosporine; Female; Humans; Liver Transplantation; Lymphoproliferative Disorders; Male; Middle Aged; Paraproteinemias; Tacrolimus

Proteinuria is an expected complication in transplant patients treated with mammalian target of rapamycin inhibitors (mTOR-i). However, clinical suspicion should always be supported by histological evidence in order to investigate potential alternate diagnoses such as acute or chronic rejection, interstitial fibrosis and tubular atrophy, or recurrent or de novo glomerulopathy. In this case we report the unexpected diagnosis of amyloidosis in a renal-transplant patient with pre-transplant monoclonal gammapathy of undetermined significance who developed proteinuria after conversion from tacrolimus to everolimus.

Topics: Allografts; Amyloidosis; Diagnosis, Differential; Everolimus; Female; Humans; Immunoglobulin G; Immunoglobulin lambda-Chains; Immunosuppressive Agents; Kidney Diseases; Kidney Transplantation; Middle Aged; Paraproteinemias; Polycystic Kidney, Autosomal Dominant; Postoperative Complications; Proteinuria; Tacrolimus; TOR Serine-Threonine Kinases

Papular elastolytic giant cell granuloma is an unusual variant of annular elastolytic giant cell granuloma. Its rarity makes the assessment of the real efficacy of any treatment difficult, as spontaneous remission is possible. We report a case whose interest, besides the rarity of the occurrence, rests in the pure papular expression of the clinical features, the association with a monoclonal gammopathy and the apparent efficacy of topical tacrolimus.

Topics: Adult; Female; Granuloma, Giant Cell; Humans; Immunosuppressive Agents; Paraproteinemias; Skin Diseases; Tacrolimus; Treatment Outcome