Kidney Transplantation After Hematopoietic Cell Transplantation in Plasma Cell Dyscrasias

V. Domínguez-Pimentel,¹ F. Fortich-Barrios,¹ O. Siverio-Morales,¹ E. Martín-Izquierdo,¹ A. Jarque-López,¹ N. Del Castillo-Rodríguez,¹ J. García,¹ P. Ríos,² M. Macía.¹

¹Division of Nephrology, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
²Division of Hematology, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.

Meeting: 2015 American Transplant Congress

Abstract number: D243

Keywords: Bone marrow transplantation, Immunosuppression, Kidney transplantation, Malignancy

Session Information

Session Name: Poster Session D: Regulatory Issues in Transplant Administration

Session Type: Poster Session

Date: Tuesday, May 5, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

INTRODUCTION:

The plasma cell dyscrasias (PCD) include a number of entities such as multiple myeloma (MM), primary amyloidosis (AL) and Monoclonal immunoglobulin deposition disease (MIDD). Hematopoietic cell transplantation (HCT) is the only cure for a variety of hematologic and oncologic diseases. Clinically significant renal impairment is a common feature in plasma cell myeloma, affecting 20-55% of patients at initial diagnosis. This circumstance is associated with a high early mortality. The needing for immunosuppression (IS) after HCT will difficult its management, and may precipitate the development of complications. In some patients an effective alternative could be kidney transplantation (KT), however the presence of two transplants will require optimal adjustment .

MATERIAL AND METHODS

From 2003-2010, in our center 540 cadaveric renal transplants were performed, where three patients were carriers of autologous HCT.

We would like to describe our experience with three patients who had a PCD and where initially receiving HCT and subsequently KT.

RESULTS

Table 1: Summary of patient data
Patient no	1	2	3
Age	46	65	42
Gender	Female	Female	Male
Diagnosis	MM	AL	MIDD
HCT date	09/05/2009	03/23/2009	03/15/2008
HCT type	Autologus	Autologus	Autologus
Time on HD	62 months	27 months	24 months
KT date	11/10/2011	05/20/2005	04/20/2010
Donor	Cadaveric	Cadaveric	Cadaveric
HLA compatibility	A3	DR14	A2- B15- DR5
Maintenance treatment	PDN+ FK	PDN+ FK	PDN+ FK
Rejections	None	None	None
MAU mg/dL	350 mg/dL	169 mg/dL	19,8 mg/dL
Recent serum Cr	0.85 mg/dL	1.6 mg/dL	1.4 mg/dL
Underlying disease treatment	Lenalidomide	–	Lenalidomide
Complications	"Infections/ Cytopenias Plasmacytoma"	Infections / CNI toxicity	Infections / Cytopenias

MM=Multiple Mieloma, AL= Primary Amyloidosis, MIDD= Monoclonal immunoglobulin deposition disease, HCT= Hematopoietic cell transplantation, KT= Kidney transplantation, HD= time on Hemodialysis, PDN= prednisone, FK= tacrolimus.

CONCLUSION

In our experience the progress and outcome of KT after HCT were optimal. We would like to address that a higher incidence of cytopenia associated with the combination of IS and other drugs should be detected together with an increase risk of opportunistic infections and the PCD relapse.

To cite this abstract in AMA style:

Domínguez-Pimentel V, Fortich-Barrios F, Siverio-Morales O, Martín-Izquierdo E, Jarque-López A, Castillo-Rodríguez NDel, García J, Ríos P, Macía M. Kidney Transplantation After Hematopoietic Cell Transplantation in Plasma Cell Dyscrasias [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplantation-after-hematopoietic-cell-transplantation-in-plasma-cell-dyscrasias/. Accessed December 3, 2024.

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