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Kidney Week

Abstract: TH-OR130

Outcomes of Kidney Transplantation in AL Amyloidosis Patients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Angel-Korman, Avital, Boston University Medical Center, Boston, Massachusetts, United States
  • Stern, Lauren D., Boston University School of Medicine, Brookline, Massachusetts, United States
  • Sarosiek, Shayna, Boston University Medical Center, Boston, Massachusetts, United States
  • Sloan, John M., Boston University Medical Center, Boston, Massachusetts, United States
  • Doros, Gheorghe, Boston University, Boston, Massachusetts, United States
  • Sanchorawala, Vaishali, Boston University School of Medicine, Brookline, Massachusetts, United States
  • Havasi, Andrea, Boston University Medical Center, Boston, Massachusetts, United States
Background

Therapies for AL amyloidosis have dramatically improved leading to longer patient survival (OS), however more patients reach end stage renal disease. Renal transplantation in patients with AL amyloidosis has been controversial due to lack of long term outcome data and appropriate and validated eligibility criteria.

Methods

We evaluated 52 patients with renal involvement who were followed in the Amyloidosis Center at Boston University Medical Center and underwent renal transplantation at various centers in the United States over the past 30 years.

Results

Median age at renal transplantation was 59.7 years (range 30.7-73.2) with 64% of transplantations from live donors. During a median follow up of 7.1 years (range 0-21), median OS from diagnosis was 16.6 years (range1-27.2), and from renal transplantation was 10.5 years. One, three and five-year graft survival were 92%, 87% and 80%, respectively. Patients with hematologic complete response (CR) or very good partial response (VGPR) at renal transplantation had a better OS than patients with partial response (PR) or no response (NR). Similarly, median time to graft loss in patients with CR/VGPR was 11.7 years (range 0.5-20.3) and with NR/PR was 5.3 years (range, 0.3-15) (HR 2.4, P=0.02). Seventeen patients (32%) had recurrent amyloidosis in the graft with median time from renal transplantation to recurrence of 3.7 years (range 0.3-11.9). Successful treatment mostly prevented graft loss in the setting of disease recurrence in the graft. There was a trend towards better OS and graft survival in patients who underwent high dose melphalan/stem cell transplantation at any time during their disease course vs. patients who were treated only with chemotherapy, however the difference did not reach statistical significance.

Conclusion

This is the largest study of patients undergoing renal transplantation for systemic AL amyloidosis to date. Carefully selected patients, particularly those who had achieved a CR and VGPR to plasma cell directed therapy at the time of renal transplantation demonstrated prolonged OS as well as graft survival. These good outcomes were independent of the type of treatment that was used for the underlying plasma cell dyscrasia. Overall and graft survival of the patients with AL amyloidosis were comparable to outcomes achieved in non-AL amyloidosis patients.

Funding

  • Private Foundation Support