Immunosuppression treatment with mTORi carries risk of ovarian cyst

Among women receiving immunosuppression treatment with mammalian target of rapamycin inhibitors (mTORi), the incidence of ovarian cyst appears to be a common adverse event, according to the results of a systematic review and meta-analysis.

Researchers searched multiple online databases for studies quantifying the frequency of ovarian cyst development during mTORi treatment. They initially identified 20 studies, of which seven were selected for inclusion in the meta-analysis. These studies involved women with type 1 diabetes mellitus (T1DM) who underwent allogeneic islet transplantation (AIT), women with polycystic kidney disease, and female renal transplant recipients.

Ovarian cyst diagnoses were based on pelvic ultrasound examination in four studies and established with magnetic resonance imaging without contrast in one study; two studies did not report the diagnostic criteria.

The total study population comprised 406 women who received sirolimus alone or in combination with other drugs, with mean follow-up ranging from 12 to 95 months. Sirolimus treatment was uptitrated until serum levels were in the range of 7–15 ng/mL. Tacrolimus target levels were between 3 and 6 ng/mL when given in combination with sirolimus, or 10 ng/mL when used in addition to mycophenolate mofetil (1 g two times per day as tolerated).

Pooled data showed that the incidence rates of ovarian cysts and clinically significant ovarian cysts were 37.0 percent (95 percent confidence interval [CI], 16.0–58.1) and 17.3 percent (95 percent CI, 5.6–29.1), respectively.

Furthermore, compared with the use of non-mTORi for immunosuppression, mTORi treatment was associated with more than a fourfold likelihood of ovarian cysts (odds ratio, 4.62, 95 percent CI, 2.58–8.28).

The present study indicate that ovarian cyst development is common during immunosuppression treatment with mTORi. Despite being benign, the cysts require pelvic ultrasound follow-up and, in some cases hospital, admission and surgery.