Monoclonal Gammopathies After Renal Transplantation: A Single-center Study |
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| Institution: | 1. Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI;2. Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI;3. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI;1. Department of Haematology, Trakya University Faculty of Medicine, Edirne, Turkey;2. Department of Haematology, Edirne Sultan 1. Murat State Hospital, Edirne, Turkey;1. Plasma Cell Disorders Division, Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, NC;2. Department of Translational Research, Levine Cancer Institute, Atrium Health, Charlotte, NC;1. Department of Hematology and Oncology, Oregon Health and Science University, Portland, OR;2. Department of Gastrointestinal and General Surgery, Oregon Health and Science University, Portland, OR;3. Department of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR;1. Department of Pathology, George Washington University, Washington, DC;2. Department of Pathology, Veterans Health Administration, Washington, DC;3. Department of Hematology and Oncology, Veterans Health Administration, Washington, DC;1. University of Central Florida College of Medicine, Orlando, FL;2. Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX;3. Department of Radiation Oncology, University of Colorado, Denver, CO;4. Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX;5. Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX |
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| Abstract: | IntroductionPlasma cell disorders (PCDs) are clonal plasma cell disorders that include conditions such as monoclonal gammopathy of undetermined significance (MGUS), monoclonal gammopathy of renal significance (MGRS), multiple myeloma (MM), smoldering MM (SMM), solitary plasmacytoma, and light-chain (AL) amyloidosis. The risk factors associated with and the clinical course of PCDs after renal transplantation is not well established although immunosuppressive protocols may impact the incidence and natural history of PCDs posttransplant.Patients and MethodsThis single-center retrospective study evaluated patients with a history of renal transplant who developed a PCD between January 1, 2014-December 31, 2018.ResultA total of 41 patients met the inclusion criteria including 29 with MGUS and 12 with symptomatic PCD (4 with MM, 2 with SMM, 4 with MGRS, 1 with AL amyloidosis, and 1 with solitary plasmacytoma). The median follow-up of survivors was 41.6 months. Three patients (1 with MGUS and 2 with MGRS) progressed to MM during the follow-up period. There was a male preponderance in both groups. There was no correlation between the donor and immunosuppressive regimen and the development of a PCD. Patients with symptomatic PCD had higher serum creatinine and M-protein levels at diagnosis and higher free light chain ratio and plasma cell burden. There was also a higher percentage of allograft failure noted in the symptomatic PCD subset 50% (n = 6), whereas only 23% (n = 7) of patients had allograft failure in the MGUS group.ConclusionThis study shows the importance of considering monoclonal gammopathy in the differential of renal dysfunction after kidney transplant and the need to follow these patients closely to monitor for progression to symptomatic PCD. |
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| Keywords: | Amyloidosis Monoclonal gammopathy Multiple Myeloma Plasma Cell Disorders Renal transplant |
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