In 2011, members from 10 different medical disciplines formed the Vanderbilt Amyloid Multidisciplinary Program (VAMP) in an effort to improve regional recognition of this rare disorder and to increase access to care and devise protocols including utilization of novel agents that would improve patient outcomes. Historically, renal transplantation was largely avoided in patients with amyloidosis as amyloid recurrence rates are unacceptably high and patient mortality far exceeds age matched controls. A goal of VAMP was to develop a renal transplant protocol that would improve access to kidney transplantation in this challenging population and render outcomes non-inferior to age matched controls. Our protocol requires consultation by cardiology, nephrology and hematology. All patients must be deemed eligible for autologous stem cell transplantation which includes age <70, complete and sustained remission from chemotherapy and minimal functional cardiac involvement as determined by cardiology (6 minute walk test, cardiac biomarkers, Echo/MRI). The patients must independently be considered renal transplant candidates based on our standard age based protocol. Lastly, the patient must have a successful autologous stem cell and remain in remission (negative bone marrow biopsy, negative free serum light chains) 1 year prior to being activated on the renal transplant list.

RESULTS: 5 patients with AL amyloidosis received 5 renal transplants (1 ddtx, 2 lurtx, 2 lrtx)

Mean age 50.8 years (38-60)

Mean time from stem cell to kidney transplant 20.4 months (7-32)

Mean follow up 44.7 months (42-87 months)

eGFR 54.8 cc/min (40-70)

Patient Survival 1/3 years 100%/100%

Graft Survival 1/3 years 100%/100%

0 renal recurrence 1 elevated serum light chains at 36 months 1 death at 42 month due to MDS

In addition we performed 2 liver/kidney (no stem cell) transplants for rare congenital liver derived amyloidosis (Fibrinogen A alpha type and APO A2)

100% patient, liver and kidney survival at 6 and 25 months respectively with egfr 68 and 54 cc/min

DISCUSSION: We believe our protocol will continue to improve access to this challenged population and produce excellent outcomes. We currently have 4 patients who have obtained a successful stem cell transplant and are wait listed for a deceased donor kidney transplant. Over time we might include multiple myeloma patients and amyloid patients with more complicated cardiac histories.

CITATION INFORMATION: Langone A., Concepcion B., Slosky D., Cornell R., Horst S., Goodman S. A Novel Protocol to Improve Kidney Transplant Outcomes in Patients with Renal Disease Due to Amyloidosis Am J Transplant. 2017;17 (suppl 3).

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