INTRODUCTION

The progression of monoclonal gammopathies following kidney transplant is not well described. Previous single-center retrospective data suggested that the course for a monoclonal gammopathy of undetermined significance (MGUS) was safe. While no progression to multiple myeloma was noted in the previous study, several cases were notable for PTLD. Here we add our center's data to the published experience.

METHODS

Patients who underwent kidney transplantation at a single center between 2002 and 2012 were reviewed. Those who had a monoclonal gammopathy by protein electrophoresis, immunofixation, or serum free light chains prior to their transplant were selected for further chart review. Outcomes of interest were progression to multiple myeloma, post-transplant lymphoproliferative disease (PTLD), recurrent disease, and allograft function.

RESULTS

Nine patients had a known monoclonal gammopathy at the time of transplantation. They ranged in age from 52 to 75, and had an average of 6 years followup (range 3-10 years). Seven patients had MGUS. Of those seven, three no longer have detectable monoclonal gammopathy. One of those three patients subsequently developed PTLD (without documented recurrence of monoclonal gammopathy). Four did not have repeat studies to quantify their monoclonal gammopathy. None of them have had any documented multiple myeloma or PTLD. Two patients' kidney disease was due to a monoclonal gammopathy. One patient with fibrillary glomerulonephritis and light chain deposition disease had recurrence in the graft requiring treatment, though now has stable kidney function off treatment seven years post-transplant. The other patient with amyloidosis had undetectable monoclonal gammopathy for four months after kidney transplant, but now has detectable monoclonal gammopathy with stable renal function off all treatment for amyloidosis at four years post-transplant.

DISCUSSION

No cases of MGUS progressed to clinical multiple myeloma. Interestingly, in three patients the monoclonal gammopathy appears to have resolved following transplantation. Whether this is due to immunosuppressive therapy is unknown. We also identified one case of PTLD, though the relationship with the previous MGUS is not clear. Monoclonal gammopathies with renal effects recurred in the transplant, though were managed with myeloma or amyloidosis treatment. Further investigation into the effect of renal transplantation on the progression of monoclonal gammopathies of unknown and or renal significance is warranted.

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