Objective: Analyze kidney allograft outcomes in patients with kidney failure due to amyloidosis, and compare kidney transplant survival to patients with other causes of kidney failure.

Methods: We reviewed the UNOS dataset for patients who underwent first kidney transplant between 10/01/1987 and 3/31/2013. We used Student's t-test to compare means, Chi-Square statistic for comparisons between nominal distributions and the Kaplan-Meier product limit method to estimate kidney allograft survival probabilities. Graft survival was compared for patients with kidney failure attributed to amyloidosis, diabetes mellitus type 1, polycystic kidney disease, and hypertension.

Results: We identified 536 patients who underwent a kidney transplant with kidney failure attributed to amyloidosis. Graft survival for patients with amyloidosis was inferior to patients with kidney failure due to hypertension and polycystic kidney disease (p<0.01, log-rank) but comparable to patients with diabetes mellitus type 1 (p=0.07, log-rank). Patient with amyloidosis were older with a mean age of 54.6 +/- 11.1 years compared to patients with diabetes mellitus who had a mean age of 42.7+/-10.6 years at transplantation (p<0.01), and were more likely to undergo a live donor kidney transplant accounting for 43.7% (n=234) of all transplants compared to 35.5% of transplants from live donors in patients with DM-1 (p<0.01).

Conclusions: In the US national kidney transplant cohort, allograft survival for patients with kidney failure due to amylodosis was inferior to patients with kidney failure due to hypertension or polycystic kidney disease, but comparable to patients with kidney failure due to diabetes mellitus type 1, a higher risk patient sub-group based on post-transplant outcomes. Based on these data, realistic expectations can be set for patients with amyloidosis with the hope of satisfactory post-transplant outcomes.

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