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Kidney Week

Abstract: PO2549

Reassessing Renal Transplantation in Light-Chain Deposition Disease

Session Information

Category: Transplantation

  • 1901 Transplantation: Basic

Authors

  • Cuadrado, Elena, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Andújar, Alicia Molina, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Esforzado, Nuria, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Cucchiari, David, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Cofan, Frederic, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Revuelta, Ignacio, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Poch, Esteban, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Diekmann, Fritz, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Quintana, Luis F., Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
Background

Light chain deposition disease (LCDD) is a systemic rare condition that usually leads to end stage renal disease. Treatment with a bortezomib-based regimen, followed by autologous stem cell transplantation (ASCT) has been increasingly used with improvements in the response rates and the renal graft outcomes in kidney transplant recipients.

Methods

Retrospective study of 6 patients diagnosed of LCDD with complete response but not renal response after hematologic treatment that underwent kidney transplant in our institution between 2010 and 2019.

Results

A total of 6 patients (5 women) were analyzed, with mean age at diagnosis of 47 years, mean eGFR of 18 mL/minute and mean proteinuria of 5.5 g. Deposit was kappa type except in 1 case (heavy and light lambda type chains). In all of them there was an absence of monoclonal component in blood and urine but positive immunofixation in 5 cases (2 only in urine). 3 started chronic hemodialysis during admission and the others at 3, 5 and 44 months after diagnosis. As hematological treatment, all received bortezomib followed by ASCT, being under complete hematological response at the time of kidney transplant, which was performed at 28 months on average from ASCT. Mean kappa/lambda ratio was 2.6. 3 patients received induction with thymoglobulin and 3 with basiliximab, followed by triple therapy with tacrolimus+prednisone+mTOR inhibitor (4 patients) or mycophenolate (2 patients). After 36 months of mean follow-up after kidney transplant, 3 patients have suffered an hematological relapse, one of them including kidney involvement with graft loss at 46 months post-transplant. The remaining 5 continue with a functional graft with a mean creatinine of 1.54 mg/dL.

Conclusion

When sustained complete hematologic response is achieved but renal impairment with dialysis requirement persists, patients could benefit from a kidney transplant with good results.