Supplementary Material for: Kaposi’s Sarcoma in a kidney transplant recipient: A case report on Paclitaxel response

Introduction
In immunocompromised individuals, particularly organ transplant recipients, the risk of developing Kaposi sarcoma (KS) increases significantly due to prolonged immunosuppressive therapy. The onset of post-transplant KS is highly variable, though most cases occur within the first two years following transplantation. The effectiveness and safety of systemic therapies in the management of post-transplant KS are not well established. In this report, we describe a rare case of early-onset KS in a Tunisian kidney transplant recipient, revealed by deep vein thrombosis just six months after transplantation, and successfully managed with paclitaxel as first-line therapy.
Case Presentation
We present the case of a 52-year-old Tunisian male who underwent a living-donor kidney transplant in June 2022. Six months after transplantation, the patient presented with deep vein thrombosis, and large purplish plaques were observed on the anterior left thigh. A skin biopsy confirmed the diagnosis of KS. Further investigations revealed systemic involvement. The patient was treated with paclitaxel-based chemotherapy in combination with sirolimus and a reduction in immunosuppressive therapy. As of November 2024, the patient had demonstrated marked clinical improvement, with resolution of KS lesions and stable renal function.
Conclusion
This case of early-onset Kaposi sarcoma highlights the potential effectiveness of paclitaxel-based chemotherapy combined with sirolimus and a carefully adjusted reduction in immunosuppressive therapy as a promising first-line treatment option.

引言
在免疫功能低下人群中，尤其是器官移植受者，由于长期接受免疫抑制治疗，罹患卡波西肉瘤（Kaposi sarcoma, KS）的风险会显著升高。移植后卡波西肉瘤的发病时间差异较大，但多数病例发生于移植术后前两年内。目前，全身治疗方案用于移植后卡波西肉瘤的诊疗管理，其有效性与安全性尚未得到充分证实。本报告描述了1例发生于突尼斯肾移植受者的早发性卡波西肉瘤罕见病例：该患者于移植术后6个月出现深静脉血栓形成，以此为首发表现，左大腿前侧可见大片紫红色斑块，并以紫杉醇作为一线治疗方案成功完成治疗。

病例报告
本文报告1例52岁突尼斯男性患者，该患者于2022年6月接受活体供肾移植术。移植术后6个月，患者出现深静脉血栓形成，查体可见左大腿前侧大片紫红色斑块。皮肤活检证实为卡波西肉瘤，进一步检查提示存在全身受累。患者接受以紫杉醇为基础的化疗，联合西罗莫司治疗，并减量免疫抑制治疗方案。截至2024年11月，患者临床症状显著改善，卡波西肉瘤病灶完全消退，肾功能维持稳定。

结论
本例早发性卡波西肉瘤病例凸显了以紫杉醇为基础的化疗联合西罗莫司，并谨慎调整免疫抑制治疗减量方案，作为极具前景的一线治疗选项的潜在疗效。