Key result
Solid organ transplant recipients experienced significantly elevated rates of 33 rare cancers compared to the general population, including a 34-fold increased risk of sebaceous adenocarcinoma.
Cohort (n=262,455)
Yes
Effect estimate: SIR 34.3 (95% CI 26.3 to 44.0)
p-value: p=<7.2 × 10^-5
Concurrent use of gemcitabine and sirolimus may synergistically increase the risk of de novo thrombotic microangiopathy in renal transplant recipients.
May warrant TMA vigilance with gemcitabine-sirolimus in renal transplants; single case leaves open synergistic risk confirmation.
BACKGROUND: Mesenteric leiomyosarcoma, a rare tumor originating from the smooth muscle of the mesentery, that may require treatment with gemcitabine based chemotherapy in advanced stages. Gemcitabine usage has been associated with the development of thrombotic microangiopathy, a risk which can be increased by concurrent use of sirolimus. CASE SUMMARY: We present the case of a young Caucasian woman with a renal transplant who developed an aggressive leiomyosarcoma. While on gemcitabine, she was noted to have acute kidney injury. Biopsy of the renal allograft revealed histological findings consistent with thrombotic microangiopathy. Sirolimus was replaced with tacrolimus, and gemcitabine was discontinued. Despite treatment with eculizumab, the allograft function continued to decline, leading to graft failure, and the patient had to be started on renal replacement therapy. CONCLUSION: This case highlights the possible synergy of gemcitabine and sirolimus in the pathogenesis of de novo thrombotic microangiopathy.
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Motla et al. (2026) conducted a cohort in Solid organ transplant recipients (n=262,455). Solid organ transplantation (immunosuppression) vs. General population was evaluated on Standardized incidence ratio of sebaceous adenocarcinoma (SIR 34.3, 95% CI 26.3 to 44.0, p=<7.2 × 10^-5). Solid organ transplant recipients experienced significantly elevated rates of 33 rare cancers compared to the general population, including a 34-fold increased risk of sebaceous adenocarcinoma.
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