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Abstract: PO2201

Donor-Derived Leukocyte Chemotactic Factor 2 Amyloidosis in Renal Allografts

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Jespersen, Tiana, University of California Davis, Sacramento, California, United States
  • Walavalkar, Vighnesh, University of California San Francisco, San Francisco, California, United States
  • Alnimri, Muna, University of California Davis, Sacramento, California, United States
  • Cheng, Mingyu, University of California Davis, Sacramento, California, United States
  • Huang, Yihung, University of California Davis, Sacramento, California, United States
  • Jen, Kuang-Yu, University of California Davis, Sacramento, California, United States
Introduction

Leukocyte chemotactic factor 2 amyloidosis (ALECT2) is a relatively common form of amyloidosis with strong ethnic predilection in the Hispanic population. Patients tend to be older and present with chronic kidney disease with variable proteinuria. Histologically, ALECT2 has a unique preference for interstitial accumulation. We report two cases of donor-derived ALECT2 in renal allografts.

Case Description

Case 1: 69-year-old (yo) Hispanic man with type II diabetes and end-stage renal disease (ESRD) received an 86% Kidney Donor Profile Index (KDPI) deceased donor renal transplant (DDRT) from a 52-yo Hispanic man who died of a stroke. The recipient had delayed graft function and suboptimal nadir serum creatinine (SCr) of 2.6 mg/dL. Proteinuria initially peaked at 2.3 g/g, which decreased to <1 g/g at 4-mo post-transplant (tx). Both time-0 and 3-mo protocol biopsies (bx) revealed widespread interstitial amyloid positive for ALECT2 on immunohistochemistry and mass spectroscopy.
Case 2: 45-yo Hispanic female with ESRD of unknown etiology received a 78% KDPI DDRT from a 60-year-old female with no medical history who died from head trauma. The recipient experienced immediate graft function with new baseline SCr of 1.2-1.6 mg/dL. She had persistent proteinuria following tx and underwent bx at 2-, 3-, and 6-mo post-tx. The bx showed mostly interstitial amyloid, later confirmed to be ALECT2. Additionally, the patient developed focal segmental glomerulosclerosis (FSGS) as well as CMV infection of the allograft. She eventually lost her graft ~2 years post-tx, likely from FSGS rather than ALECT2.

Discussion

Rare cases of donor-derived ALECT2 have been reported in the literature and suggest that kidney allografts with limited and localized donor-derived ALECT2 involving <10% of the renal parenchyma have good outcomes. Our cases represent more severely affected donor kidneys. Although the clinical course for our patients were suboptimal, other factors aside from ALECT2 were likely the major contributing factors. Thus, donor-derived ALECT2 is likely of low consequence in the recipient allograft.