Abstract: SA-PO1034
Donor-Derived Leukocyte Chemotactic Factor 2 Amyloidosis (ALECT2) in a Kidney Transplant Recipient with Preexisting Monoclonal Gammopathy of Undetermined Significance (MGUS)
Session Information
- Transplantation: Clinical - Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Er Rbii, Fedoua, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Kwan, Hana K., Fort Sam Houston Military and Family Readiness Center, Joint Base San Antonio Fort Sam Houston, Texas, United States
- Bhayana, Suverta, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Patel, Rupal, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Introduction
ALECT2 is predominantly seen among individuals of Mexican descent, and mostly leads to a slow progression of chronic kidney disease. Donor-derived cases of ALECT2 without associated impairment of allograft function have been reported. However, data on long-term transplant outcomes in the setting of ALECT2 remain limited. In patients with underlying MGUS, transplantation presents added complexity, given the potential for progression to multiple myeloma. Moreover, if monoclonal gammopathy of renal significance (MGRS) is not identified and addressed prior to surgery, disease recurrence within the allograft is a known concern. Here, we present a case of donor-derived ALECT2 amyloidosis, incidentally discovered in a kidney transplant recipient with preexisting MGUS and concern for MGRS.
Case Description
A 63-year-old male with past medical history of hypertension, IgG kappa MGUS, and CKD stage 5 due to hypertension. He underwent kidney transplantation from an unrelated Mexican living donor. A pre-transplant renal biopsy was limited and inconclusive for MGRS, but negative for amyloidosis. Approximately 2 months after transplant, patient had an increase in serum creatinine and an allograft biopsy showed renal amyloidosis with no signs of acute rejection. Amyloid typing confirmed ALECT2. Mass spectroscopy showed low counts of kappa light chains in the background given the patient's known MGUS. Re-evaluation of the zero-hour kidney biopsy with Congo red staining showed amyloid deposits, consistent with donor-derived amyloidosis. Renal function returned to baseline spontaneously, and decision was made to clinically monitor the recipient and donor.
Discussion
This case highlights the importance of comprehensive pre-transplant evaluation and post-transplant monitoring in patients with plasma cell dyscrasias. This approach is crucial to determine whether post-transplant disease processes reflect recurrence, progression of an underlying condition, or a donor-derived disease. Additionally, it underscores the need for further data to determine the transplant suitability of kidneys with leukocyte chemotactic factor 2 (LECT2) amyloid deposits, as well as the long-term safety of living donation from individuals with subclinical ALECT2.