Long Term Outcomes of Kidney Transplantation in Patients with AL-Amyloidosis – The Mayo Clinic Experience
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, 2School of Medicine, Dokuz Eylul University, Izmir, Turkey, 3National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing, China, 4Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, 5Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ, 6Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 7Department of Transplant Surgery, Mayo Clinic, Rochester, MN
Meeting: 2020 American Transplant Congress
Abstract number: B-090
Keywords: Biopsy, Graft survival, Kidney transplantation, Monoclonal antibodies
Session Information
Session Name: Poster Session B: Kidney Complications: Non-Immune Mediated Late Graft Failure
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: New clone-directed therapies and better definition of hematological response criteria allows assessment of post-kidney transplantation outcomes in patients with light-chain (AL) amyloidosis
*Methods: Patients with AL amyloidosis (n=75) were classified based on hematological response at kidney transplant(KTx). Groups were: no response (NR) plus partial response (PR) (n=13, 17.3%), very good partial response (VGPR) plus complete response (CR) (n=53, 70.7%), and treatment-naive (n=9, 12.0%). Clinical outcomes were recorded for death, graft failure and complications.
*Results: Majority of KTx (n=57, 76.0%) were living-related donor and maintained on tacrolimus, mycophenolate mofetil, and prednisone (85.3%). During a median follow-up of 63 months (IQR, 24-105), 5 patients lost the allograft (6.7%) and 24 (32.0%) patients died with a functioning graft. After kidney transplantation, 77.8% of the treatment-naive group achieved a CR. Patient survival at 5 years for NR+PR, VGPR+CR, and treatment-naive groups was 48.4%, 91.1%, and 77.8%, respectively. The overall median patient survival was 123 months, but 60 months in NR+PR group, 117 months in treatment-naive group. Median time to graft loss was 197 months in the all sample, but 105 months in NR+PR group, 197 months in treatment-naive group. In the VGPR+CR, median time to graft loss and patient survival were not reached(p<0.001). Acute rejection was seen in 15 subjects (20.0%), of which 12 rejection episodes occurred at first year (80.0%) and 9 were within the first 4 months (60.0%). Recurrence of amyloid was seen in 18 patients (24.0%), with median time to recurrence of 122 months in all patients. Amyloid recurrence was identified by protocol biopsies in 13 of 18 subjects (72.2%), however this was only concurrently with clonal reemergence in 11 patients. 7 patients had histological recurrence without paraprotein detection. Survival of patients with amyloid recurrence and patients free of recurrence were not significantly different (p=0.296).
*Conclusions: Outcomes of patients with AL-amyloidosis after kidney transplant are good when a hematological remission is achieved. AL amyloidosis carries high mortality on dialysis and when guided by good response to clonal therapies allows successful kidney transplantation outcomes for patients, with active intervention on surveillance.
To cite this abstract in AMA style:
Bentall A, Heybali C, Wen J, Hatem A, Schinstock CA, Lorenz E, Ters MEl, Mai M, Khamash H, Murray D, Stegall MD, Cosio FG, Alexander MP, Leung N. Long Term Outcomes of Kidney Transplantation in Patients with AL-Amyloidosis – The Mayo Clinic Experience [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-outcomes-of-kidney-transplantation-in-patients-with-al-amyloidosis-the-mayo-clinic-experience/. Accessed May 31, 2025.« Back to 2020 American Transplant Congress