| Literature DB >> 32712168 |
Cihan Heybeli1, Andrew Bentall2, Jiqiu Wen3, Mariam Priya Alexander4, Francis K Buadi5, Fernando G Cosio2, Patrick G Dean6, Angela Dispenzieri5, David Dingli5, Mireille El Ters2, Morie A Gertz5, Amer Hatem2, Prashant Kapoor5, Hasan Khamash7, Taxiarchis Kourelis5, Shaji Kumar5, Elizabeth C Lorenz2, Martin Mai8, Eli Muchtar5, David L Murray9, Mikel Prieto6, Carrie A Schinstock2, Mark D Stegall6, Rahma Warsame5, Nelson Leung10.
Abstract
Longer survival using modern therapies has increased the number of patients with immunoglobulin light-chain amyloidosis receiving kidney transplantation. We evaluated 60 patients with immunoglobulin light chain amyloidosis who underwent kidney transplantation based on their hematologic response for outcomes of death, graft failure, and complications. Patient hematologic responses (light-chain in blood or urine) prior to kidney transplantation were three patients had no response, five had a partial response, six had a very good partial response, 37 had a complete response, and nine were treatment-naive patients (never treated for this disorder). After transplantation, seven of nine treatment-naive patients achieved a complete response. The median follow-up for the entire transplant cohort was 61 months. The estimated median overall survival from the time of kidney transplantation was 123 months for the entire group. Median overall survival was not reached for the very good partial response plus complete response groups, it was 47 months for no response plus partial response groups, and 117 months for the treatment-naive group (all significantly different). Median overall survival of very good partial response was 81 months, while the median was not reached in the complete response group (no significant difference). The time to amyloid recurrence was significantly longer in complete response compared to very good partial response (median 181 vs 81 months). Death-censored graft survival at one- and five-years was 98.3%, and 95.8%, respectively for all groups. Of the 60 patients, three had allograft failure, 19 died with a functioning graft, and 13 had an amyloid recurrence. Thus, outcomes after kidney transplant in patients with immunoglobulin light-chain amyloidosis seem acceptable if a very good partial response or complete response is achieved either before or after transplantation.Entities:
Keywords: kidney transplantation; mass spectrometry; monoclonal gammopathy
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Year: 2020 PMID： 32712168 PMCID： PMC8411566 DOI： 10.1016/j.kint.2020.06.036
Source DB: PubMed Journal: Kidney Int ISSN： 0085-2538 Impact factor: 10.612