Abstract: SA-PO955

Successful Kidney Transplantation and Chronic Lymphocytic Leukemia: A Case Report

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Nazmul, Mohammed, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Miles, Clifford D., University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Chilluru, Vamsi Krishna, None, Omaha, Nebraska, United States
  • Mullane, Ryan, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Westphal, Scott G., None, Omaha, Nebraska, United States
Background

Active malignancies are typically considered as contraindication to kidney transplantation. Chronic lymphocytic leukemia (CLL) has variable prognosis; many have indolent course, with median survival up to 10 years, and some centers are considering the role of kidney transplantation in patients with active CLL who develop advanced kidney disease. Concerns related to transplantation include influence of immunosuppression on disease progression, possibility for leukemic infiltration of the allograft and increased risk of infectious complications. Few cases of kidney transplantation into patients with CLL have been described, however allograft and patient outcomes have been discouraging with high rate of graft failure and mortality. We report a patient with CLL treated with Bruton Tyrosine Kinase inhibitor, ibrutinib, underwent successful renal transplantation with relatively uncomplicated post-transplant course.

Methods

A 50-year-old man was diagnosed with CLL/small lymphocytic lymphoma Rai stage 0 with favorable cytogenetics. He was managed conservatively initially, but later treated with cyclophosphamide and maintenance rituximab due to declining renal function. Kidney biopsy revealed IgA nephropathy with CLL renal involvement characterized by lymphocytic interstitial infiltrate. He progressed to end-stage kidney disease requiring hemodialysis. He completed two years of rituximab and was later transitioned to maintenance therapy with ibrutinib which controlled his CLL with stable WBC counts and no infections .
Given clinical stability and favorable prognosis, he was approved for kidney transplantation and received a deceased donor kidney transplant (KDPI 67%) with basiliximab induction followed by maintenance immunosuppression including tacrolimus, mycophenolate sodium and prednisone. He is now 1.5 years out from his transplant and had a successful allograft outcome with serum creatinine 1.0 mg/dl (eGFR 76 ml/min) at last check. There have been no infectious complications. He has maintained a persistent lymphocytosis, but has not had adverse allograft injury related to his CLL.

Conclusion

Patients with CLL have often been excluded for consideration for kidney transplantation, newer therapies and improved understanding of favorable prognostic markers may allow for safe kidney transplantation in carefully selected patients.