TY - JOUR
T1 - A study from The Mayo Clinic evaluated long-term outcomes of kidney transplantation in patients with immunoglobulin light chain amyloidosis
AU - Heybeli, Cihan
AU - Bentall, Andrew
AU - Wen, Jiqiu
AU - Alexander, Mariam Priya
AU - Buadi, Francis K.
AU - Cosio, Fernando G.
AU - Dean, Patrick G.
AU - Dispenzieri, Angela
AU - Dingli, David
AU - El Ters, Mireille
AU - Gertz, Morie A.
AU - Hatem, Amer
AU - Kapoor, Prashant
AU - Khamash, Hasan
AU - Kourelis, Taxiarchis
AU - Kumar, Shaji
AU - Lorenz, Elizabeth C.
AU - Mai, Martin
AU - Muchtar, Eli
AU - Murray, David L.
AU - Prieto, Mikel
AU - Schinstock, Carrie A.
AU - Stegall, Mark D.
AU - Warsame, Rahma
AU - Leung, Nelson
N1 - Funding Information:
CH received grant support from the Turkish Society of Nephrology .
Publisher Copyright:
© 2020 International Society of Nephrology
PY - 2021/3
Y1 - 2021/3
N2 - Longer survival using modern therapies has increased the number of patients with immunoglobulin light-chain amyloidosis receiving kidney transplantation. We evaluated 60 patients with immunoglobulin light chain amyloidosis who underwent kidney transplantation based on their hematologic response for outcomes of death, graft failure, and complications. Patient hematologic responses (light-chain in blood or urine) prior to kidney transplantation were three patients had no response, five had a partial response, six had a very good partial response, 37 had a complete response, and nine were treatment-naive patients (never treated for this disorder). After transplantation, seven of nine treatment-naive patients achieved a complete response. The median follow-up for the entire transplant cohort was 61 months. The estimated median overall survival from the time of kidney transplantation was 123 months for the entire group. Median overall survival was not reached for the very good partial response plus complete response groups, it was 47 months for no response plus partial response groups, and 117 months for the treatment-naive group (all significantly different). Median overall survival of very good partial response was 81 months, while the median was not reached in the complete response group (no significant difference). The time to amyloid recurrence was significantly longer in complete response compared to very good partial response (median 181 vs 81 months). Death-censored graft survival at one- and five-years was 98.3%, and 95.8%, respectively for all groups. Of the 60 patients, three had allograft failure, 19 died with a functioning graft, and 13 had an amyloid recurrence. Thus, outcomes after kidney transplant in patients with immunoglobulin light-chain amyloidosis seem acceptable if a very good partial response or complete response is achieved either before or after transplantation.
AB - Longer survival using modern therapies has increased the number of patients with immunoglobulin light-chain amyloidosis receiving kidney transplantation. We evaluated 60 patients with immunoglobulin light chain amyloidosis who underwent kidney transplantation based on their hematologic response for outcomes of death, graft failure, and complications. Patient hematologic responses (light-chain in blood or urine) prior to kidney transplantation were three patients had no response, five had a partial response, six had a very good partial response, 37 had a complete response, and nine were treatment-naive patients (never treated for this disorder). After transplantation, seven of nine treatment-naive patients achieved a complete response. The median follow-up for the entire transplant cohort was 61 months. The estimated median overall survival from the time of kidney transplantation was 123 months for the entire group. Median overall survival was not reached for the very good partial response plus complete response groups, it was 47 months for no response plus partial response groups, and 117 months for the treatment-naive group (all significantly different). Median overall survival of very good partial response was 81 months, while the median was not reached in the complete response group (no significant difference). The time to amyloid recurrence was significantly longer in complete response compared to very good partial response (median 181 vs 81 months). Death-censored graft survival at one- and five-years was 98.3%, and 95.8%, respectively for all groups. Of the 60 patients, three had allograft failure, 19 died with a functioning graft, and 13 had an amyloid recurrence. Thus, outcomes after kidney transplant in patients with immunoglobulin light-chain amyloidosis seem acceptable if a very good partial response or complete response is achieved either before or after transplantation.
KW - kidney transplantation
KW - mass spectrometry
KW - monoclonal gammopathy
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U2 - 10.1016/j.kint.2020.06.036
DO - 10.1016/j.kint.2020.06.036
M3 - Article
C2 - 32712168
AN - SCOPUS:85099912255
SN - 0085-2538
VL - 99
SP - 707
EP - 715
JO - Kidney international
JF - Kidney international
IS - 3
ER -