Abstract: TH-PO1042
ALECT2 Amyloidosis Kidney Transplant Outcomes in the Contemporary Era: A Single-Center Experience with Longitudinal Graft Function and Donor-Derived Cell-Free DNA Monitoring
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
- Mijagiri, Jayanand D., Houston Methodist, Houston, Texas, United States
- Adrogue, Alexander Horacio, University of California San Francisco School of Medicine, San Francisco, California, United States
- Edwards, Angelina, Houston Methodist, Houston, Texas, United States
- Adrogue, Horacio E., Houston Methodist, Houston, Texas, United States
Background
ALECT2 amyloidosis is a relatively recently identified form of renal amyloidosis and cause of ESRD that preferentially affects Hispanic/Latino populations. Fewer than 20 transplant cases have been reported globally and without any standardized post-transplant surveillance protocol.
Methods
Retrospective chart review of biopsy-confirmed ALECT2 transplant recipients from 2024–2025 using EPIC EMR. Serial creatinine, tacrolimus (FK506) troughs, Prospera dd-cfDNA, and HLA/DSA data were collected.
Results
Significant improvements were noted in creatinine after transplant. Dd-cfDNA remained below the 1.0% rejection threshold, though transient elevations were noted which correlated with clinical events (subtherapeutic tacrolimus levels, intermittent DSA reactivation). There has not been evidence of recurrence at this time in either patient.
Conclusion
Sustained graft function of both patients was noted. Multimodal surveillance integrating creatinine, tacrolimus, Prospera dd-cfDNA, and DSA captured meaningful signals missed by creatinine alone in this underserved population. To our knowledge, this is the first reported application of Prospera dd-cfDNA in ALECT-2 recipients. Multicenter prospective collaboration is needed to establish evidence-based surveillance protocols.
Patient Demographics and Tranplant Characteristics
| Age/Sex/BMI | 65F | BMI 26.3 | 58M | BMI 25.9 |
| Ethnicity | Hispanic/Latino | Hispanic/Latino |
| Blood Type | O Positive | A Positive |
| Comorbidities | HTN, HLD, Breast Cancer | HTN, HepB, HLD, MGUS |
| Dx -> Transplant | ~4 years (Dx 2020) | ~3 years (Dx 2022) |
| Transplant type | LRKT | LUDKT |
| Induction | Thymoglobulin | Thymoglobulin |
| Immunosuppresion | Envarsus 2.5mg + Prednisone 5 mg daily | Prograf 2.5mg + MMF 500mg BID |
| Pre- Tx DSA/XM | B49 cPRA 4% | XM Negative | B67 cPRA 0% | XM Neg |
HTN=Hypertension; HLD=Hyperlipidemia; HepB=treated Hepatitis B; MGUS=Monoclonal Gammopathy of Undetermined Significance; LRKT=Living Related KT; LUDKT=Living Unrelated Donor KT;MMF=Mycophenolate Mofetil; XM=crossmatch; DSA=donor-specific antibody; cPRA=calculated panel reactive antibody; Dx=diagnosis; Tx=transplant.