PDF(Pubmed)
Abstract：
The mammalian target of rapamycin (mTOR) inhibitors are used to prevent organ transplant rejection and are preferred over other immunosuppressants due to its low nephrotoxicity. However, mTOR inhibitors have been associated with various adverse effects including lymphedema. Although rare in incidence, previously known treatments for mTOR inhibitor-induced lymphedema were limited to discontinuation of related drugs and complex disruptive therapy with variable results. In this article, three patients who developed lymphedema in their lower limbs after using mTOR inhibitors, including two bilateral and one unilateral case, were treated with physiologic surgery methods such as lymphovenous anastomosis (LVA) and lymph node transfer. The efficacy of the treatment was evaluated. In the three cases described, cessation of the drug did not lead to any reduction in edema. The use of LVA and lymph node transfer resulted in early reductions in volume but failed to sustain over time. All patients underwent secondary nonphysiologic surgery such as liposuction resulting in sustained improvement. This series presents the first physiologic approach to mTOR inhibitor-induced lymphedema. Although further study is warranted, the physiologic surgical options may have limited success and nonphysiologic options may offer better sustainable results.
摘要：
哺乳动物雷帕霉素靶(mTOR)抑制剂用于预防器官移植排斥,并且由于其低肾毒性而优于其他免疫抑制剂。然而,mTOR抑制剂与包括淋巴水肿在内的各种不良反应有关。虽然发病率罕见，以前已知的mTOR抑制剂诱导的淋巴水肿治疗方法仅限于停用相关药物和复杂的破坏性治疗,结果不一.在这篇文章中,三名患者在使用mTOR抑制剂后出现下肢淋巴水肿，包括两个双边案件和一个单方面案件，采用淋巴静脉吻合术（LVA）和淋巴结转移等生理性手术方法进行治疗。评价治疗的疗效。在描述的三个案例中，停药不会导致水肿的任何减少。使用LVA和淋巴结转移导致早期体积减少，但随着时间的推移未能维持。所有患者均接受二次非生理手术，例如吸脂术，从而持续改善。本系列介绍了mTOR抑制剂诱导的淋巴水肿的第一个生理方法。尽管需要进一步研究，生理性手术选择可能取得有限的成功,非生理性手术选择可能提供更好的可持续结果.
