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CC BY 4.0 · Arch Plast Surg 2024; 51(03): 321-326
DOI: 10.1055/a-2201-5881
Extremity/Lymphedema
Case Report

Does Lymphovenous Anastomosis Effect Mammalian Target of Rapamycin Inhibitor-associated Lymphedema Patients?

Inah Yoon 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Hyung Bae Kim 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Jeongmok Cho 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Changsik John Pak 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Hyunsuk Peter Suh 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Jae Yong Jeon 
2   Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Joon Pio Hong 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
› Author Affiliations Funding None.
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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.

Keywords

mTOR inhibitors - sirolimus - lymphedema - immunosuppressive agents - lipectomy

Authors' Contributions

I.Y.: preliminary draft and data collection

rest of authors: data evaluation and draft correction

J.P.H.: final correction, hypothesis management.


Ethical Approval

The study was exempted from approval by the Institutional Review Board of Asan Medical Center (IRB No. 2022-1138) and performed in accordance with the principles of the Declaration of Helsinki.


Patient Consent

The patients provided written informed consent for the publication.




Publication History

Received: 02 April 2023

Accepted: 23 October 2023

Accepted Manuscript online:
30 October 2023

Article published online:
04 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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