Outcomes of Renal Disease Related to Monoclonal Gammopathy After Kidney Transplantation: A Single Center Experience.
Nephrology, Cleveland Clinic, Cleveland
Meeting: 2017 American Transplant Congress
Abstract number: B142
Keywords: Kidney transplantation, Post-transplant malignancy
Session Information
Session Name: Poster Session B: Kidney Complications II
Session Type: Poster Session
Date: Sunday, April 30, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Kidneys are commonly involved in patients with monoclonal gammopathies (MG). However, the role of kidney transplants (KTx) in MG still needs to be more clearly defined. One review of 8 case reports noted average renal and patient survival of 35 months in patients with multiple myeloma (MM). Another retrospective study of monoclonal immunoglobulin deposition disease (MIDD) reported recurrence in 5/7 patients after KTx. We report our institute's experience with patients with MG diagnosed prior to KTx
We performed a retrospective chart review study on patients in our database with KTx between 01/2001 till 12/2015. Out of total 2890 patients, 115 were found to have MG based on serum or urine immunofixation and ICD 10 code. A manual chart review was done on these 115 patients; 37 patients were identified with MG prior to the KTx and 37 after the KTx.
Results:
Among those 37 patients diagnosed prior to KTx, 23 had MGUS, 13 had kidney disease related to MG and 1 had smoldering myeloma (SM).
Out of these 14 patients, 8 (57 %) had recurrence or progression of the disease and 1 lost to follow-up.
| Disease(n) | Median Age at KTx (yrs) | Gender (n) | MG Outcome (n) | Time to event after KTx (median) |
| Myeloma kidney(4) | 56 years | Female (2)
Male (2) |
MM (2)
Stable (2)* |
16 months |
| MIDD (7) | 64 years | Male (5)
Female (2) |
MM(2)
MIDD (1) Lymphoplasmacytic lymphoma (1) Proximal tubulopathy (1) Stable (2) |
84 months |
| MPGN (1) | 66 years | Male | Lost follow up | NA |
| TMA (1) | 63 years | Male | C3 GN | 1 week |
| SM | 55 years | Male | Amyloidosis | 90 months |
All 14 (100%) patients were alive with functioning graft at 1-year post-KTx, 13/14 (92 %) patients were alive with functioning graft at 3 years. However, in terms of long-term patient and graft survival (Median follow-up 4.7 years, range 1.4-14 years ), 4(28.5 %) patients had stable graft function, 5(35.7 %) had reduced graft function, 1(7 %) was alive with failed graft and 4 were (28 %) deceased.
2 patients without recurrence after KTX had combined autologous stem cell TX and KTx for MM.*
Out 23 patients with MGUS, only 1/23 (4 %) developed proximal tubulopathy.
Conclusion: Patients with MG related kidney disease have a high rate of recurrence and progression after KTx. In addition, they have increased rates of long-term graft dysfunction and poor patient survival. These patients should be carefully counseled and selected before KTx.
CITATION INFORMATION: Kaur T, Poggio E, Nurko S. Outcomes of Renal Disease Related to Monoclonal Gammopathy After Kidney Transplantation: A Single Center Experience. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kaur T, Poggio E, Nurko S. Outcomes of Renal Disease Related to Monoclonal Gammopathy After Kidney Transplantation: A Single Center Experience. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-renal-disease-related-to-monoclonal-gammopathy-after-kidney-transplantation-a-single-center-experience/. Accessed November 21, 2024.« Back to 2017 American Transplant Congress