High Incidence of Ovarian Cysts in Women Receiving mTOR Inhibitors After Renal Transplantation.

Abstract

Ovarian cysts are a common finding in reproductive-aged females. Most of them are functional cysts that typically resolve spontaneously and require no treatment. However, ovarian cysts may also be adverse events associated with inhibitors of the mammalian target of rapamycin (mTOR). Both approved mTOR inhibitors everolimus and sirolimus are widely used as immunosuppressive agents after organ transplantation. The aim of this study was to compare the effect of mTOR inhibitors vs. non-mTOR inhibitor immunosuppression on the incidence, size and complication rate of ovarian cysts in renal transplant recipients. We retrospectively analysed 571 consecutive female kidney transplant patients in our centre between 2000 and 2008. The follow-up period was extended through December 31st, 2012. 102 (17.8%) patients received mTOR inhibitors for at least one month after transplantation. We identified 44 women (7.7%) with new ovarian cysts. Ovarian cysts were significantly more frequent among patients receiving mTOR inhibitors (20.5%) than in the control group (4.9%; p < 0.001). Also the hospitalization rate was higher (p = 0.05) in the mTOR group and ten patients (47.6%) requiring surgery. Future prospective studies are required to determine the underlying cause of ovarian toxicity and treatment strategies have to be developed in order to avoid severe complications.