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Abstract: PO2133

Monoclonal Gammopathy in Kidney Transplanted Patients: Novel Insights into Long-Term Outcomes

Session Information

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
Men90 (62)45 (68)45 (57)0.17
Age at KT60 [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.