A 49-year-old renal transplant recipient on cyclosporine-based immunosuppression develops multiple violaceous cutaneous nodules. Biopsy confirms Kaposi sarcoma positive for HHV-8. Which change in immunosuppression offers both tumour control and continued graft protection?

• A Increase prednisolone dose
• B Switch calcineurin inhibitor to sirolimus ✓
• C Add azathioprine
• D Stop all immunosuppression immediately

Explanation

Sirolimus inhibits mTOR signalling, which is required for HHV-8-driven endothelial cell proliferation, giving it a direct antitumour effect against Kaposi sarcoma while still providing immunosuppression. Conversion from a calcineurin inhibitor to sirolimus leads to regression of cutaneous lesions in many reported recipients. Simply intensifying prednisolone or adding azathioprine worsens immunosuppression and tumour growth, whereas abrupt withdrawal risks graft loss, so neither is acceptable.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.