Living donor kidney and autologous stem cell transplantation for primary systemic amyloidosis (AL) with predominant renal involvement

Nelson Leung, Matthew D. Griffin, Angela Dispenzieri, Eric N. Haugen, James M. Gloor, Thomas R. Schwab, Stephen C. Textor, Martha Q. Lacy, Mark R. Litzow, Fernando G. Cosio, Timothy S. Larson, Morie A. Gertz, Mark D. Stegall

Research output: Contribution to journalArticlepeer-review

66 Scopus citations


Primary systemic amyloidosis (AL) is characterized by multiorgan deposition of monoclonal immunoglobulin light chain. Renal involvement is common and impaired kidney function is associated with reduced median survival. Autologous stem cell transplantation (SCT) for AL achieves superior response rates compared to chemotherapy alone but patients with end-stage renal disease (ESRD) may be excluded from consideration. A treatment approach consisting of living donor kidney transplantation (LDKTx) followed by autologous SCT was developed for AL with ESRD. Eight patients underwent LDKTx with immediate graft function. Two suffered unanticipated complications post-KTx and died 10 and 3 months later. Two cases of subclinical acute cellular rejection (ACR) and one case of clinical ACR occurred-all reversible with corticesteroid. Six patients had successful stem cell harvests performed and five of these underwent SCT with satisfactory trilineage engraftment. Renal function remained stable following SCT in four and was reduced in one due to infectious and bleeding complications. One patient, who has thus far elected not to undergo SCT, has proteinuria and histologic evidence of recurrent renal amyloidosis. This experience supports the feasibility of sequential living donor KTx and autologous SCT for carefully selected patients with ESRD due to AL.

Original languageEnglish (US)
Pages (from-to)1660-1670
Number of pages11
JournalAmerican Journal of Transplantation
Issue number7
StatePublished - Jul 2005


  • AL amyloidosis
  • End stage renal disease
  • Kidney transplantation
  • Stem cell transplantation
  • Therapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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