Abstract: SA-PO0191
Clinical Patterns and Outcomes of AL Amyloid Recurrence After Kidney Transplant
Session Information
- Onconephrology: MGRS, HSCT, Electrolytes, RCC, and More
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Jalal, Abdullah, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Jaturapisanukul, Solos, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Leung, Nelson, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Prior studies have shown that AL amyloidosis patients can successfully undergo kidney transplantation with good outcomes. This study examines hematologic, renal characteristics of AL amyloidosis recurrence - crucial insights for optimal outcomes in this challenging patient population.
Methods
This retrospective cohort study evaluated 66 patients with AL amyloidosis that underwent kidney transplant from 1999 to 2018 at Mayo Clinic Rochester. Linear regression, ROC curve analysis and Kaplan-Meier method were used.
Results
With a median follow-up of 62 months, 26 of the 66 patients had AL amyloid recurrence post-transplant. Recurrences were detected by protocol biopsy in 30.8% of patients. Patients with lambda light chain (LC) AL amyloidosis have a higher risk of recurrence versus kappa LC (51% vs 22%), and complete hematologic response (CR) was associated with a longer time to recurrence (128 vs 62 months). A dFLC ≥1.85 was predictive for recurrent amyloid (OR 13.3, 95% CI 3.48-68.2). There was no association between the last hematologic treatment and time to recurrence.
Conclusion
Our results show that lambda iFLC, non-CR response and dFLC ≥1.85 are associated with a higher risk of AL amyloidosis recurrence post-renal transplant.
Baseline Characteristics
| Baseline characteristics | Total (n=66) | No recurrence (n=40) | Recurrence (n=26) | P-value |
| Age at kidney transplant (years) | 58 ± 8.4 | 59.1 ± 7.2 | 56.3 ± 10 | 0.2 |
| Male sex, n (%) | 42 (63.6) | 26 (65) | 16 (61.5) | 0.8 |
| Lambda free light chain involves, n (%) | 39 (59.1) | 19 (47.5) | 20 (76.9) | 0.02 |
| Best hematologic response prior kidney transplant, n (%) - CR - VGPR - PR - NR - Treatment-naive | 35 (53) 15 (22.7) 6 (9.1) 2 (3) 8 (12.1) | 26 (65) 7 (17.5) 1 (2.5) 1 (2.5) 5 (12.5) | 9 (34.6) 8 (30.8) 5 (19.2) 1 (3.8) 3 (11.5) | 0.04 |
| Induction for Kidney Transplant - No induction - ATG - Basiliximab - Daclizumab - Alemtuzumab | 3 (4.8) 21 (33.3) 33 (52.4) 1 (2.6) 5 (7.9) | 2 (5.1) 16 (41) 18 (46.2) 1 (1.6) 2 (5.1) | 1 (4.2) 5 (20.8) 15 (62.5) 0 3 (12.5) | 0.375 |
| Clinical presentation at recurrence, n (%) - Protocol Biopsy - Rising serum creatinine* - New onset proteinuria** - Rising serum creatinine AND new proteinuria | n/a | n/a | 8 (30.8) 12 (46.2) 4 (15.4) 2 (7.7) | n/a |
| Serum creatinine, mg/dL (IQR) | n/a | 1.6 (1.3-2) | 1.6 (1.1-2) | 0.74 |
| 24-hour urine protein, g (IQR) | n/a | 0.2 (0.1-0.3) | 0.3 (0.1-0.7) | 0.05 |
Protocol Biopsy (no aberrant serum or urine biomarkers); *Cr≥0.3 mg/dL; **Urine protein≥0.5 g above post-transplant nadir or ≥1g/24 hr
A) Higher recurrence risk with lambda iFLC
B) Longer time to recurrence in CR vs VGPR
C) dFLC >1.85 predictive of recurrence, independent of iFLC
D) Box plot of dFLC levels pre-, post-, and at recurrence