Effectiveness of Complex Decongestive Therapy in Managing Everolimus-Induced Secondary Lymphedema Post-Renal Transplantation: A Case Report

Amal Alshaiji, bharat muni
Purpose:

The primary goal was to assess the effectiveness of CDT in treating Everolimus-induced secondary lymphedema in a renal transplant patient's upper limb. A secondary objective was to emphasize the importance of early detection and intervention to reduce complications from this drug-related condition.

Methods:
A 34-year-old female with stable renal graft function following a July 2013 transplant presented with significant swelling and discomfort in her right arm three months after beginning Everolimus as part of a triple immunosuppressive regimen. Lymphoscintigraphy confirmed impaired lymphatic drainage, and the diagnosis of secondary lymphedema was made. On initial examination, the right arm had a 48.89% volume increase compared to the left. Stemmer’s sign was positive, although pitting edema was absent. The patient underwent three weeks of intensive CDT, which included manual lymphatic drainage, short-stretch bandaging, decongestive exercises, fibrosis management, and skin care. Following the intensive phase, the patient was fitted with a custom-made Class III compression garment with a silver liner and was advised to follow a self-care protocol.

Results:

After three weeks of intensive CDT, the patient showed significant improvement. The volume of the right arm decreased from 2.01L to 1.75L, a reduction of 12.94%. With continued therapy, the volume further decreased to 1.49L, reflecting a total reduction of 25.87%. The left arm, serving as a control, maintained a constant volume of 1.35L. Additionally, skin condition improved, fibrosis was reduced, and Stemmer’s sign became negative. A follow-up lymphoscintigraphy in May 2024 showed enhanced lymphatic flow and improved tracer activity in the antecubital lymph nodes.

Conclusion(s):

This case highlights the potential for Everolimus to cause secondary lymphedema and demonstrates the effectiveness of CDT in managing it. Early recognition and prompt, intensive treatment using CDT, combined with custom compression garments, significantly reduced limb volume and improved the patient’s quality of life. A total reduction of 25.87% in limb volume, along with improved lymphatic function, emphasizes the importance of early intervention. Further research is needed to develop clinical guidelines for managing drug-induced lymphedema, particularly in transplant recipients.

Implications:

The case underscores the need for increased clinician awareness of Everolimus-induced lymphedema. Timely management using CDT can prevent disease progression and improve patient outcomes. More research is needed to establish guidelines for managing drug-induced lymphedema.

Funding acknowledgements:
This study did not receive any funding.
Keywords:
Everolimus-induced lymphedema
Complex Decongestive Therapy
secondary lymphedema
Primary topic:
Disability and rehabilitation
Second topic:
Other
Did this work require ethics approval?:
No
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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