| Autor: |
Heybeli, Cihan, Alexander, Mariam Priya, Bentall, Andrew, Amer, Hatem, Buadi, Francis, Dean, Patrick G, Dingli, David, Dispenzieri, Angela, El Ters, Mireille, Gertz, Morie A, Issa, Naim, Kapoor, Prashant, Kourelis, Taxiarchis, Kukla, Aleksandra, Kumar, Shaji, Lacy, Martha Q, Lorenz, Elizabeth C, Muchtar, Eli, Murray, David, Nasr, Samih H, Prieto, Mikel, Rajkumar, Vincent, Schinstock, Carrie A, Stegall, Mark, Warsame, Rahma, Leung, Nelson |
| Jazyk: |
angličtina |
| Rok vydání: |
2021 |
| Předmět: |
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| Zdroj: |
Am J Kidney Dis |
| Popis: |
RATIONALE & OBJECTIVE: Data on kidney transplantation (KTx) outcomes among patients with monoclonal gammopathy of renal significance (MGRS) are lacking. STUDY DESIGN: Case series of patients with MGRS, some of whom received clone-directed therapies prior to KTx. SETTING & PARTICIPANTS: Thirty patients who underwent KTx from 1987 through 2016 after diagnosis with MGRS-associated lesions including light chain deposition disease (LCDD), C3-glomerulopathy with monoclonal gammopathy (C3G-MG), and light chain proximal tubulopathy (LCPT). FINDINGS: Of the 19 patients with LCDD, 10 were treated prior to KTx while 9 were treatment-naive. Among the treated LCDD patients, 3 (30%) experienced histologic recurrence, 2 (20%) developed graft failure, and 2 (20%) had mortality during median follow-up of 70 (3–162) months after KTx. In the treatment-naive LCDD group, 8 (89%) had histologic recurrence, 6 (67%) grafts failed, and 4 (44%) patients died, during the median follow-up of 60 (35–117) months. Of the 5 patients who achieved complete response (CR) prior to KTx, none died, and only 1 had experienced graft failure 162 months after the KTx. Three of 5 patients with C3G-MG were treatment-naive prior to KTx. Both of the patients who were treated before KTx had histologic recurrence, 1 developed graft failure and 1 died. Among the 3 treatment-naive C3G-MG patients, histologic recurrence occurred in all, while graft loss and mortality were observed in 2, and 1 patients, respectively. In the LCPT group (n=4), histologic recurrence was noted in all 3 patients who did not receive clone-directed therapies before KTx, and 2 of these patients died, 1 with a functioning kidney. The only patient with LCPT who received therapy prior to KTx did not have histologic recurrence, graft loss, or mortality. LIMITATIONS: Small sample size, non-standardized managements, retrospective design. CONCLUSIONS: Recurrence is very common in all MGRS-associated lesions after KTx. Achieving a complete hematologic response may reduce the risk of recurrence, graft loss, and mortality. More studies are needed to determine effects of hematologic response on outcomes in each MGRS-associated lesion. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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