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Kidney Week

Abstract: PO2159

Outcomes of Renal Transplantation in Patients with AL Amyloidosis: An International Collaboration Through the International Kidney and Monoclonal Gammopathy (IKMG) Research Group

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Havasi, Andrea, Boston University, Boston, Massachusetts, United States
  • Heybeli, Cihan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Leung, Nelson, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Angel-Korman, Avital, Boston University, Boston, Massachusetts, United States
  • Sanchorawala, Vaishali, Boston University, Boston, Massachusetts, United States
  • Cohen, Oliver C., National Amyloidosis Centre, London, London, United Kingdom
  • Wechalekar, Ashutosh D., National Amyloidosis Centre, London, London, United Kingdom
  • Bridoux, Frank, Department of Nephrology, CIC INSERM 1402, CHU Poitiers, Poitiers, France; Centre national de référence Amylose AL & autres maladies par dépôts d'immunoglobulines monoclonales, CHU Poitiers, Poitiers, France; Centre National de la Recherche Scientifique UMR CNRS 7276/INSERM U1262, Université de Limoges, Limoges, France, Limoges, France
  • Jaffer Sathick, Insara, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Milani, Paolo, Amyloidosis Research and Treatment Center, University ofFoundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo” and Department of Molecular Medicine, University of Pavia, Pavia, Italy, Pavia, Italy
  • Palladini, Giovanni, Amyloidosis Research and Treatment Center, University ofFoundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo” and Department of Molecular Medicine, University of Pavia, Pavia, Italy, Pavia, Italy
  • Merlini, Giampaolo, Amyloidosis Research and Treatment Center, University ofFoundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo” and Department of Molecular Medicine, University of Pavia, Pavia, Italy, Pavia, Italy
  • Hegenbart, Ute, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany, Heidelberg, Germany
  • Schönland, Stefan O., Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany, Heidelberg, Germany
  • Landau, Heather, Memorial Sloan Kettering Cancer Center, New York, New York, United States

Group or Team Name

  • The International Kidney and Monoclonal Gammopathy (IKMG) Research Group
Background

New systemic therapies that successfully suppress toxic light chain production have led to an increase in the number of patients with AL amyloidosis who survive longer albeit with end stage renal disease. There is a critical need to identify patients in this specific population who can have good outcomes with renal transplantation.

Methods

We evaluated renal transplant outcomes in 237 patients from 5 countries with AL amyloidosis who underwent renal transplantation between 1987 and 2020. Cox regression analysis and Kaplan–Meier method were used.

Results

The majority of the patients (62%) underwent high dose melphalan and autologous stem cell transplantation (HDM/SCT). Overall survival (OS) from renal transplantation was 8.6 years with a median follow-up of 8.5 years. One-, three- and five-year OS from renal transplantation was 95%, 83% and 73%, respectively. The median time of graft survival was 7.8 years. Death censored graft survival at one-, three- and five-years was 92%, 79% and 69%, respectively. Survival outcomes were analyzed based on degree of hematologic response to therapy at the time of renal transplantation. Overall and graft survival were better in patients with complete hematologic response and very good partial response (CR+VGPR) compared to partial response, no response or treatment naive (PR+NR+TN). Amyloid recurrence rate in the graft was lower (16% vs 37%, p=0.01) and the time to amyloid recurrence was significantly longer in the CR+VGPR group (median time not achieved vs 10 years, p=0.001). Comparing CR vs. VGPR there was no difference in OS and graft survival. A total of 69 patients (29%) experienced hematologic relapse requiring treatment post renal transplantation. Graft survival for those who had a hematologic relapse was not statistically different from that of patients without relapse. Successful hematologic treatment prevented graft loss in 87% of patients who had amyloid recurrence in the graft.

Conclusion

Our results show that selected patients with AL amyloidosis undergoing kidney transplantation have good outcomes.