De novo AL amyloidosis in the kidney allograft

Qi Qian, S. H. Nasr, M. E. Fidler, L. D. Cornell, Sanjeev M Sethi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

We report four cases of de novo amyloidosis occurring after 16, 18, 28 and 31 years following kidney transplantation. These patients presented with proteinuria and progressive allograft dysfunction. Kidney biopsy showed AL amyloidosis in all compartments of the allograft kidney. Serumimmunofixation studies revealed monoclonal lambda light chains in all four cases. Bone marrow examination showed 10% plasma cells in one case, 5-10% in two cases and less than 5% in one case. Two patients died unexpectedly within 3 months and 1 year of the diagnosis of allograft AL amyloidosis. Of the remaining two, one underwent autologous stem cell transplant that resulted in complete hematologic remission. However, the patient relapsed within 2 years and also developed progressive kidney allograft failure. The patient received a second autologous stem cell transplant with complete hematologic response, followed by a second kidney transplant, which showed no evidence of amyloid at 1-year posttransplant. The remaining casewas treated with prednisone and bortezomib, which has stabilized kidney function in the short term. In conclusion, this study shows that AL amyloidosis is an uncommon but important cause of late onset proteinuria in the kidney allograft that results in kidney allograft failure.

Original languageEnglish (US)
Pages (from-to)606-612
Number of pages7
JournalAmerican Journal of Transplantation
Volume11
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Amyloidosis
Allografts
Kidney
Transplants
Proteinuria
Renal Insufficiency
Stem Cells
Bone Marrow Examination
Prednisone
Plasma Cells
Amyloid
Kidney Transplantation
Biopsy
Light

Keywords

  • AL amyloidosis
  • Allograft
  • De novo amyloidosis
  • Kidney transplant

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

De novo AL amyloidosis in the kidney allograft. / Qian, Qi; Nasr, S. H.; Fidler, M. E.; Cornell, L. D.; Sethi, Sanjeev M.

In: American Journal of Transplantation, Vol. 11, No. 3, 03.2011, p. 606-612.

Research output: Contribution to journalArticle

Qian, Qi ; Nasr, S. H. ; Fidler, M. E. ; Cornell, L. D. ; Sethi, Sanjeev M. / De novo AL amyloidosis in the kidney allograft. In: American Journal of Transplantation. 2011 ; Vol. 11, No. 3. pp. 606-612.
@article{9744b552b24f4d3db14e251b6ccd1167,
title = "De novo AL amyloidosis in the kidney allograft",
abstract = "We report four cases of de novo amyloidosis occurring after 16, 18, 28 and 31 years following kidney transplantation. These patients presented with proteinuria and progressive allograft dysfunction. Kidney biopsy showed AL amyloidosis in all compartments of the allograft kidney. Serumimmunofixation studies revealed monoclonal lambda light chains in all four cases. Bone marrow examination showed 10{\%} plasma cells in one case, 5-10{\%} in two cases and less than 5{\%} in one case. Two patients died unexpectedly within 3 months and 1 year of the diagnosis of allograft AL amyloidosis. Of the remaining two, one underwent autologous stem cell transplant that resulted in complete hematologic remission. However, the patient relapsed within 2 years and also developed progressive kidney allograft failure. The patient received a second autologous stem cell transplant with complete hematologic response, followed by a second kidney transplant, which showed no evidence of amyloid at 1-year posttransplant. The remaining casewas treated with prednisone and bortezomib, which has stabilized kidney function in the short term. In conclusion, this study shows that AL amyloidosis is an uncommon but important cause of late onset proteinuria in the kidney allograft that results in kidney allograft failure.",
keywords = "AL amyloidosis, Allograft, De novo amyloidosis, Kidney transplant",
author = "Qi Qian and Nasr, {S. H.} and Fidler, {M. E.} and Cornell, {L. D.} and Sethi, {Sanjeev M}",
year = "2011",
month = "3",
doi = "10.1111/j.1600-6143.2010.03418.x",
language = "English (US)",
volume = "11",
pages = "606--612",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - De novo AL amyloidosis in the kidney allograft

AU - Qian, Qi

AU - Nasr, S. H.

AU - Fidler, M. E.

AU - Cornell, L. D.

AU - Sethi, Sanjeev M

PY - 2011/3

Y1 - 2011/3

N2 - We report four cases of de novo amyloidosis occurring after 16, 18, 28 and 31 years following kidney transplantation. These patients presented with proteinuria and progressive allograft dysfunction. Kidney biopsy showed AL amyloidosis in all compartments of the allograft kidney. Serumimmunofixation studies revealed monoclonal lambda light chains in all four cases. Bone marrow examination showed 10% plasma cells in one case, 5-10% in two cases and less than 5% in one case. Two patients died unexpectedly within 3 months and 1 year of the diagnosis of allograft AL amyloidosis. Of the remaining two, one underwent autologous stem cell transplant that resulted in complete hematologic remission. However, the patient relapsed within 2 years and also developed progressive kidney allograft failure. The patient received a second autologous stem cell transplant with complete hematologic response, followed by a second kidney transplant, which showed no evidence of amyloid at 1-year posttransplant. The remaining casewas treated with prednisone and bortezomib, which has stabilized kidney function in the short term. In conclusion, this study shows that AL amyloidosis is an uncommon but important cause of late onset proteinuria in the kidney allograft that results in kidney allograft failure.

AB - We report four cases of de novo amyloidosis occurring after 16, 18, 28 and 31 years following kidney transplantation. These patients presented with proteinuria and progressive allograft dysfunction. Kidney biopsy showed AL amyloidosis in all compartments of the allograft kidney. Serumimmunofixation studies revealed monoclonal lambda light chains in all four cases. Bone marrow examination showed 10% plasma cells in one case, 5-10% in two cases and less than 5% in one case. Two patients died unexpectedly within 3 months and 1 year of the diagnosis of allograft AL amyloidosis. Of the remaining two, one underwent autologous stem cell transplant that resulted in complete hematologic remission. However, the patient relapsed within 2 years and also developed progressive kidney allograft failure. The patient received a second autologous stem cell transplant with complete hematologic response, followed by a second kidney transplant, which showed no evidence of amyloid at 1-year posttransplant. The remaining casewas treated with prednisone and bortezomib, which has stabilized kidney function in the short term. In conclusion, this study shows that AL amyloidosis is an uncommon but important cause of late onset proteinuria in the kidney allograft that results in kidney allograft failure.

KW - AL amyloidosis

KW - Allograft

KW - De novo amyloidosis

KW - Kidney transplant

UR - http://www.scopus.com/inward/record.url?scp=79951990915&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79951990915&partnerID=8YFLogxK

U2 - 10.1111/j.1600-6143.2010.03418.x

DO - 10.1111/j.1600-6143.2010.03418.x

M3 - Article

C2 - 21342449

AN - SCOPUS:79951990915

VL - 11

SP - 606

EP - 612

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 3

ER -