TY - JOUR
T1 - Kidney Transplantation in Patients With Monoclonal Gammopathy of Renal Significance (MGRS)–Associated Lesions
T2 - A Case Series
AU - Heybeli, Cihan
AU - Alexander, Mariam Priya
AU - Bentall, Andrew J.
AU - Amer, Hatem
AU - Buadi, Francis K.
AU - Dean, Patrick G.
AU - Dingli, David
AU - Dispenzieri, Angela
AU - El Ters, Mireille
AU - Gertz, Morie A.
AU - Issa, Naim S.
AU - Kapoor, Prashant
AU - Kourelis, Taxiarchis
AU - Kukla, Aleksandra
AU - Kumar, Shaji
AU - Lacy, Martha Q.
AU - Lorenz, Elizabeth C.
AU - Muchtar, Eli
AU - Murray, David L.
AU - Nasr, Samih H.
AU - Prieto, Mikel
AU - Rajkumar, S. Vincent
AU - Schinstock, Carrie A.
AU - Stegall, Mark D.
AU - Warsame, Rahma
AU - Leung, Nelson
N1 - Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2022/2
Y1 - 2022/2
N2 - Rationale & Objective: Data on kidney transplantation outcomes among patients with monoclonal gammopathy of renal significance (MGRS) are lacking. Study Design: Case series of patients with MGRS, some of whom received clone-directed therapies before kidney transplantation. Setting & Participants: 28 patients who underwent kidney transplantation from 1987 through 2016 after diagnosis with MGRS-associated lesions including light-chain deposition disease (LCDD), C3 glomerulopathy with monoclonal gammopathy (C3G-MG), and light-chain proximal tubulopathy (LCPT). Findings: Of the 19 patients with LCDD, 10 were treated before kidney transplantation and 9 were treatment-naive. Among the treated patients with LCDD, 3 (30%) experienced histologic recurrence, 2 (20%) grafts failed, and 2 (20%) died during a median follow-up of 70 (range, 3-162) months after transplant. In the treatment-naive LCDD group, 8 (89%) had histologic recurrence, 6 (67%) grafts failed, and 4 (44%) patients died during a median follow-up of 60 (range, 35-117) months. Of the 5 patients who had a complete response before transplant, none died, and only 1 experienced graft failure, 162 months after transplant. Of 5 patients with C3G-MG, 3 were treatment-naive before transplant. Both patients who were treated before transplant had histologic recurrence, and 1 experienced graft failure and died. Among the 3 patients with treatment-naive C3G-MG, histologic recurrence occurred in all, and graft loss and death were observed in 2 and 1, respectively. In the LCPT group (n = 4), histologic recurrence was observed in all 3 patients who did not receive clone-directed therapies before transplant, and 2 of these patients died, 1 with a functioning kidney. The 1 patient with LCPT who received therapy before transplant did not have histologic recurrence or graft loss and survived. Limitations: Small sample size, nonstandardized clinical management, retrospective design. Conclusions: Recurrence is very common in all MGRS-associated lesions after kidney transplant. Achieving a complete hematologic response may reduce the risks of recurrence, graft loss, and death. More studies are needed to determine the effects of hematologic response on outcomes for each MGRS-associated lesion.
AB - Rationale & Objective: Data on kidney transplantation outcomes among patients with monoclonal gammopathy of renal significance (MGRS) are lacking. Study Design: Case series of patients with MGRS, some of whom received clone-directed therapies before kidney transplantation. Setting & Participants: 28 patients who underwent kidney transplantation from 1987 through 2016 after diagnosis with MGRS-associated lesions including light-chain deposition disease (LCDD), C3 glomerulopathy with monoclonal gammopathy (C3G-MG), and light-chain proximal tubulopathy (LCPT). Findings: Of the 19 patients with LCDD, 10 were treated before kidney transplantation and 9 were treatment-naive. Among the treated patients with LCDD, 3 (30%) experienced histologic recurrence, 2 (20%) grafts failed, and 2 (20%) died during a median follow-up of 70 (range, 3-162) months after transplant. In the treatment-naive LCDD group, 8 (89%) had histologic recurrence, 6 (67%) grafts failed, and 4 (44%) patients died during a median follow-up of 60 (range, 35-117) months. Of the 5 patients who had a complete response before transplant, none died, and only 1 experienced graft failure, 162 months after transplant. Of 5 patients with C3G-MG, 3 were treatment-naive before transplant. Both patients who were treated before transplant had histologic recurrence, and 1 experienced graft failure and died. Among the 3 patients with treatment-naive C3G-MG, histologic recurrence occurred in all, and graft loss and death were observed in 2 and 1, respectively. In the LCPT group (n = 4), histologic recurrence was observed in all 3 patients who did not receive clone-directed therapies before transplant, and 2 of these patients died, 1 with a functioning kidney. The 1 patient with LCPT who received therapy before transplant did not have histologic recurrence or graft loss and survived. Limitations: Small sample size, nonstandardized clinical management, retrospective design. Conclusions: Recurrence is very common in all MGRS-associated lesions after kidney transplant. Achieving a complete hematologic response may reduce the risks of recurrence, graft loss, and death. More studies are needed to determine the effects of hematologic response on outcomes for each MGRS-associated lesion.
KW - Monoclonal gammopathy of renal significance (MGRS)
KW - case series
KW - graft loss
KW - hematologic response
KW - kidney transplantation
KW - plasma cell disorder
KW - recurrence
KW - renal transplant
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U2 - 10.1053/j.ajkd.2021.04.015
DO - 10.1053/j.ajkd.2021.04.015
M3 - Article
C2 - 34175375
AN - SCOPUS:85114165933
SN - 0272-6386
VL - 79
SP - 202
EP - 216
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -