Monoclonal gammopathy of unknown significance in kidney transplanted patients: novel insights into long-term outcomes.

Autor:	Meuleman MS; Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France., Mouyabi S; Department of Nephrology, CHU Poitiers, Vienne, France. Centre de référence « Amylose AL et autres maladies à dépôts d'immunoglobuline monoclonales»., Gueguen J; Department of Nephrology, CHU Tours, Idre et Loire, France., Vicca S; Biochemistry Laboratory, Hôpital Necker, APHP, Paris, France., Divard G; Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France., Aubert O; Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France., Bienaimé F; Service d'Explorations Fonctionnelles rénales, Hôpital Necker, APHP. Université de, Paris, France.; Institut Necker Enfant Malade, INSERMU1151, Paris, France., Arnulf B; Hematology and Oncology, Hôpital Saint Louis, APHP, France. Université de Paris, France., Anglicheau D; Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France., Bridoux F; Department of Nephrology, CHU Poitiers, Vienne, France. Centre de référence « Amylose AL et autres maladies à dépôts d'immunoglobuline monoclonales»., Cohen C; Department of Nephrology and Transplantation, Hôpital Necker, APHP. Université de Paris Cité, France.; Stress and cancer laboratory, INSERM U830, Institut Curie, Paris, France.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2023 Dec 20; Vol. 39 (1), pp. 64-73.
DOI:	10.1093/ndt/gfad144
Abstrakt:	Background: Because of increased access to kidney transplantation in elderly subjects, the prevalence of monoclonal gammopathies of unknown significance (MGUS) in kidney transplantation (KT) is growing. However, little is known about the consequences of MGUS on long-term outcomes. Methods: We identified 70 recipients with MGUS present at transplantation (KTMG) and 114 patients with MGUS occurring after KT (DNMG), among 3059 patients who underwent a KT in two French kidney transplantation centers. We compared outcomes of KTMG with those of matched controls. Results: Baseline characteristics were similar except for an older age in KTMG compared with the DNMG group (62 vs 57 years, P = .03). Transient MGUS occurred more frequently in DNMG patients (45% vs 24%, P = .007). When compared with matched controls without MGUS, KTMG patients showed higher frequency and earlier post-transplant solid cancers (15% vs 5%, P = .04) and a trend for more bacterial infections (63% vs 48%, P = .08), without difference regarding patient and graft survival, rejection episodes or hematological complications. KTMG patients with an abnormal kappa/lambda ratio and/or severe hypogammaglobulinemia at the time of KT experienced shorter overall survival. Conclusions: MGUS detection at the time of KT is neither associated with a higher occurrence of graft rejection, nor adversely affects graft or overall survival. MGUS should not contraindicate KT. However, MGUS at the time of KT may be associated with higher risk of early neoplastic and infectious complications and warrants prolonged surveillance. Measurement of serum free light chain should be performed before transplant to refine the risk evaluation of KTMG patients and propose personalized follow-up and immunosuppression. (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
Databáze:	MEDLINE
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