Kidney Week

Abstract: FR-PO907

Plasma Cell Neoplasms After Renal Allograft: A Single-Center Experience

Session Information

• Transplantation: Translational and Transplant Pathology
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Bhosekar, Chitra, Medical College of Wisconsin, Menomonee Falls, Wisconsin, United States

Chitra Bhosekar,

• Chongkrairatanakul, Tepsiri, Medical College of Wisconsin, Menomonee Falls, Wisconsin, United States

Tepsiri Chongkrairatanakul,

• D'Souza, Anita, Medical College of Wisconsin, Menomonee Falls, Wisconsin, United States

Anita D'Souza,

• Bhasin, Bhavna, Medical College of Wisconsin, Menomonee Falls, Wisconsin, United States

Bhavna Bhasin,

Background

Plasma cell disorders (PCD) are B-cell neoplasms that develop as a consequence of dysregulated B-cell clonal proliferation. The various types of PCD include monoclonal gammopathy of unknown significance (MGUS), multiple myeloma (MM) and monoclonal gammopathy of renal significance (MGRS). PCD and their complications can impact graft survival and other outcomes following kidney transplantation (KT). This underscores the need to investigate the natural history of PCD after KT.

Methods

Retrospective chart review was done at our institution in patients >18 years who had KT between 2008 and 2017 to identify those developing PCD after KT. Patients with a PCD before KT were excluded from the study.

Results

Of the 711 patients who received KT, 12 (1.68%) developed PCD. Three patients developed MM, 2 developed MGRS and 7 had MGUS in the post-transplant course. The study population was predominantly male (75%). Patients in the MM group were younger (mean age 54 years, range 47-67) than those in the MGUS (mean age 57, range 39-69) and MGRS groups (mean age 80 years, range 74-86) at the time of transplant. The mean time from transplant to PCD was 2.9, 3.2 and 4.6 years respectively in the MGRS, MGUS and MM groups. Mean follow up of survivors in the study was 5.9 years. Epstein Barr virus (EBV) positivity was noted in all 3 MM patients but in 50% of MGRS and 28% of MGUS groups. The mean creatinine at last follow up was higher (2 mg/dL) in MM subjects and was similar (1.7 mg/dL) in the MGRS and MGUS groups. Induction and maintenance immunosuppressive regimens used were similar in three groups. One MM patient died 3 years after diagnosis but all other patients were alive with a functioning graft at last follow up.

Conclusion

We found an incidence of new PCD after KT of 1.68% over a 10-year period after KT, which is similar to the incidence of post-transplant lymphoproliferative disorder (1.5%-2%). The risk of developing MM may be higher in patients who are transplanted at a younger age though the time from transplant to diagnosis may be longer than other types of PCD. EBV status at KT may influence development of MM post-transplant suggesting a role of immunosuppression. These findings merit further examination in a larger study.