Living donor kidney transplantation is an effective option of renal replacement therapy in patients with light-chain amy
- PDF / 167,090 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 71 Downloads / 171 Views
LETTER TO THE EDITOR
Living donor kidney transplantation is an effective option of renal replacement therapy in patients with light-chain amyloidosis (AL) Elena Guillen 1 & Enrique Montagud-Marrahi 1 & Diana M. Rodriguez 1 & Evelyn Hermida 1 & Raul A. Padilla 1,2 & Miquel Blasco 1 & M. Teresa Cibeira 3 & Rodrigo Martino 4 & Carlos Fernandez de Larrea 3 & J. M. Campistol 1 & Luis F. Quintana 1 Received: 14 August 2020 / Accepted: 24 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, Despite the improved survival of patients with amyloid light-chain (AL) amyloidosis in the last decades [1, 2], the role of kidney transplantation (KT) in patients with amyloidosis-associated end-stage renal disease (ESRD) remains controversial [3]. Herein we describe our experience in three patients with AL amyloidosis who received a living-donor (LD) KT after achieving complete hematological response, two of them from an unrelated donor and one from an HLA identical donor (Table 1). All three achieved complete renal function recovery during the first week, but two patients developed allograft dysfunction due to the recurrence of AL amyloidosis, both confirmed by kidney biopsy. The first patient developed the recurrence 27 months post-transplantation, presenting with proteinuria (1.7 g/24 h) without kidney function impairment, increased lambda free light chain (FLC) (64 mg/L) with ratio κ/λ 0.15 mg/L, and 10% of plasma cells in the bone marrow aspiration. The second patient developed the recurrence 84 months post-transplantation, presenting with proteinuria (1.6 g/24 h) with preserved kidney function, increased lambda FLC (130 mg/L) with ratio κ/λ 0.21 mg/L, and 8% of plasma cells. Both received 6 cycles of bortezomib, cyclophosphamide, and dexamethasone followed by 6 more cycles without bortezomib as salvage treatment. After that, complete hematologic remission was achieved in both cases, with preserved kidney function. The third patient presented hematological relapse without renal involving 3 years after KT, achieving
complete response after targeted treatment with lenalidomide and prednisone. It is widely known that KT for patients with amyloidosis-associated ESRD is still contentious because of concern for recurrence of amyloid deposition on the transplanted organ [4], although with the introduction of high-dose melphalan and autologous stem cell transplant, as well as new agents such as proteasome inhibitors and, more recently, anti-CD38 monoclonal antibodies, higher rates of complete hematologic remission and longer response durations have been described [5–7]. In this regard, the largest cohorts of KT recipients with AL amyloidosis have been recently published [8, 9], including 49 patients from 1987 to 2017 and 16 patients from 1999 to 2018, respectively. Both series showed good outcomes in AL amyloidosis selected patients, most of them from LD (65% and 87%, respectively), suggesting that KT in this population might be more than a reasonable option in those patients without significant extra
Data Loading...
