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Abstract: SA-PO841

Lenalidomide and Risk of Acute Rejection in the Kidney Allograft

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Zuquello, Radames Adamo, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
  • Zonoozi, Shahrzad, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
  • Chauhan, Suman, Washington DC VA Medical Center, Washington, District of Columbia, United States
  • Li, Ping, Washington DC VA Medical Center, Washington, District of Columbia, United States
  • Cohen, Scott D., Washington DC VA Medical Center, Washington, District of Columbia, United States
Introduction

Solid Organ Transplant is associated with an increased incidence of malignancy. It is important to understand the complications of chemotherapy and potential interactions with maintenance immunosuppression.

Case Description

72yo male with ESKD secondary to FSGS received a deceased donor kidney transplant in 2008, DM, HTN, prostate CA, and recently diagnosed multiple myeloma (M M) who presented with abdominal pain. He was found to have AKI, Screat 6.9mg/dl from 1.2, with hydronephrosis and partially obstructing ureteral stone. He underwent percutaneous nephrostomy, he did not recover kidney function and required hemodialysis. Patient underwent allograft biopsy which showed grade 2A acute T cell-mediated rejection (TCMR). There was severe tubulointerstitial inflammation, tubulitis, and a focus of endothelialitis. 16/35 sclerosed glomeruli, moderate interstitial fibrosis and tubular atrophy. He was treated with IV methylprednisolone followed by IV thymoglobulin. Patient remained on tacrolimus 5mg BID and mycophenolic acid 360mg BID.It is unusual to see severe TCMR 13 years after his kidney transplant. He had no previous episodes of rejection with stable kidney function. Two months prior to presentation, he was started on chemotherapy for MM with bortezomib, lenalidomide and dexamethasone. The third cycle of chemotherapy was held. The patient had tacrolimus trough levels ranging from < 0.75µ/L to 4.4µ/L during the months leading up to presentation. Despite treatment patient continued to have dialysis dependent AKI without signs of recovery.

Discussion

Lenalidomide is associated with acute rejection in solid organ transplantation. A possible mechanism is activation of T-cells with secretion of interferon gamma and interleukin-2 leading to stimulation of CD8 and CD4+ helper T-cells promoting activation of the immune system. It is important to be aware of the potential complications of immunomodulatory chemotherapy which can increase risk of TCMR. Management of post transplant malignancies is challenging and requires a multidisciplinary approach.