Abstract: TH-PO1014
Outcomes of Kidney Transplant Recipients in the Era of Clone-Directed Therapy: A Case Series
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Mahfouz, Ratib Talal, Cleveland Clinic, Cleveland, Ohio, United States
- Obeidat, Yasin, Cleveland Clinic, Cleveland, Ohio, United States
- Valent, Jason, Cleveland Clinic, Cleveland, Ohio, United States
- Fatica, Richard A., Cleveland Clinic, Cleveland, Ohio, United States
- Poggio, Emilio D., Cleveland Clinic, Cleveland, Ohio, United States
- Khouri, Jack, Cleveland Clinic, Cleveland, Ohio, United States
- Owoyemi, Itunu O., Cleveland Clinic, Cleveland, Ohio, United States
Background
Multiple myeloma (MM) causes kidney impairment in up to 50% of patients yet has historically been considered a contraindication to kidney transplantation (KTx) due to high recurrence risk. Clone directed therapies have improved MM outcomes, prompting reconsideration of KTx eligibility. Data remain limited to small series with heterogeneous treatment eras. We report outcomes of six MM patients who underwent KTx after achieving deep hematologic responses.
Methods
Six patients (median age 66, range 51-69) underwent KTx. All had standard cytogenetic risk (R-ISS stage II-III), and all received clone directed agents pre-KTx; three underwent prior autologous stem cell transplant (ASCT) with median ASCT-to-KTx interval of 22 months (range 14-30). Best pre-KTx response was CR (n=4) or VGPR (n=2). Median time from diagnosis to KTx was 37 months (range 18-198), and median duration of sustained hematologic response prior to KTx was 20 months (range 16-175). Five received deceased donor KTx and one living donor KTx. Induction immunsuppression is basiliximab or thymoglobulin. All patients received post-KTx anti-myeloma maintenance therapy, most commonly daratumumab-based.
Results
At median follow-up of 29 months post-KTx (range 11-49), 4 patients were alive without relapse. One experienced hematologic relapse at 25 months post-KTx, treated with daratumumab followed by venetoclax-based therapy. One patient relapsed at 35 months post-KTx and died of progressive MM at 49 months. BK viremia occurred in 3, CMV viremia in 2, and secondary cutaneous malignancies in 2. No graft failures occurred.
Conclusion
This series demonstrates that kidney transplantation is feasible in selected MM patients achieving deep, sustained hematologic responses with current therapies. Post-KTx anti-myeloma maintenance were safely co-administered with transplant immunosuppression. Intensive monitoring for viral reactivation, secondary malignancies, and hematologic relapse remains essential to improve patient and allograft outcomes.
Demographics and Outcomes of KTx Recipients and MM
| Patient | Age/Sex | Pre-KTx Tx | ASCT (Time to KTx) | Last response pre-KTx | Post-KTx maintenance | Relapse (time) | Rejection | Terminal eGFR | Death |
| 1 | 67/F | Lenalidomide, ixazomib | No | CR | Ixazomib | No | No | 94 | No |
| 2 | 67/M | CyBorD, D-KRd, lenalidomide + bortezomib | Yes (22 mo) | VGPR | Bortezomib + lenalidomide | No | No | 29 | No |
| 3 | 65/M | VCd, DVd, DRd | Yes (30 mo) | VGPR | Daratumumab faspro, VenBorDex | Yes (25 mo) | TCMR | 38 | No |
| 4 | 69/F | RVD | Yes (14 mo) | CR | Daratumumab | No | No | 61 | Yes |
| 5 | 64/M | VCd, DVd | No | CR | Daratumumab | No | No | 67 | No |
| 6 | 51/F | DVD, SGN-40 | No | CR | Lenalidomide + Dex, VTd, KCRd, IDd + daratumumab + pomalidomide | Yes (35 mo) | TCMR | 30 | Yes |