Abstract: PO2133
Monoclonal Gammopathy in Kidney Transplanted Patients: Novel Insights into Long-Term Outcomes
Session Information
- Transplantation: Clinical - Underrecognized Risk Factors, Traditional Considerations, and Outcomes
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Meuleman, Marie-Sophie, Hopital universitaire Necker-Enfants malades, Paris, Île-de-France, France
- Gueguen, Juliette, Hopital universitaire Necker-Enfants malades, Paris, Île-de-France, France
- Vicca, Stephanie, Hopital universitaire Necker-Enfants malades, Paris, Île-de-France, France
- Aubert, Olivier, Hopital universitaire Necker-Enfants malades, Paris, Île-de-France, France
- Arnulf, Bertrand, Hopital Saint-Louis, Paris, Île-de-France, France
- Anglicheau, Dany, Hopital universitaire Necker-Enfants malades, Paris, Île-de-France, France
- Bridoux, Frank, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Cohen, Camille, Hopital universitaire Necker-Enfants malades, Paris, Île-de-France, France
Background
Monoclonal gammopathy(MG) is a frequent condition affecting 0,05 to 6% of general population. Little is known about the prevalence of MG and its consequences on long-term outcomes in the setting of kidney transplantation(KT).
Methods
We conducted a monocentric retrospective cohort study based on 2272 patients who underwent a KT from January 2007 to June 2019 at Necker Hospital Paris, France. A systematic extraction of serum protein electrophoresis(SPE) results performed during this period was used to distinguish patients with MG at the time of KT(MGKT) and patients who developed de novo MG(DVMG) after KT. Serum free light chain(sFLC) were retrospectively measured on stored frozen sera from MGKT patients, taken at the day of KT.
Results
We identified 66 patients with MGKT and 79 with DVMG. Patient’s characteristics are summarized in Table 1. Eleven (6%) patients developed a hematological disorder, i.e. post transplantation lymphoid disorder (n=6) and multiple myeloma (n=5), without difference between groups. Infectious complications were similarly frequent, regarding viral (n=68, 47%), bacterial (n= 96, 66%) and fungal infections (n=12, 14%). Strikingly, median overall survival was significantly lower in MGKT patients compared to DVMG patients (78 months vs not reached, respectively, p=0.005). The five MGKT patients with an abnormal sFLC ratio (<0,3 or >3,3) at the time of KT tended to have lower OS compared to those with normal sFLC ratio (p= 0.07), suggesting that abnormal FLC ratio might represent a risk factor for early death in KT recipients. Death censored graft survival was not different between groups.
Conclusion
By analyzing the most important cohort of KT patients with MG reported to date, we found that MGKT affects overall survival and that sFLC measurement at the time of KT may refine risk stratification. Measurement of sFLC and SPE should be incorporated to the pre-transplant evaluation workup.
General characteristics
All N=145 | KTMG N=66 | DVMG N=79 | P value | |
Men | 90 (62) | 45 (68) | 45 (57) | 0.17 |
Age at KT | 60 [50-67] | 62 [56-67] | 57 [43-69] | 0.06 |
Heavy chain isotype, n=144 IgG / IgA / IgM | 112 (78) / 18 (13) / 14(10) | 46 (71) / 12 (19) / 7 (11) | 66 (84) / 6 (8) / 7 (9) | 0.12 |
Light chain isotype, n=143 Lambda / Kappa | 74 (52) /69 (48) | 37 (57) / 28 (43) | 37 (47) / 41 (53) | 0.31 |
Qualitative variables are described as n (percentages), quantitative variables as median [interquartile range]
Funding
- Government Support – Non-U.S.