TY - JOUR
T1 - Kidney Transplantation in Patients With Monoclonal Gammopathy of Renal Significance (MGRS)–Associated Lesions
T2 - A Case Series
AU - Heybeli, Cihan
AU - Alexander, Mariam Priya
AU - Bentall, Andrew J.
AU - Amer, Hatem
AU - Buadi, Francis K.
AU - Dean, Patrick G.
AU - Dingli, David
AU - Dispenzieri, Angela
AU - El Ters, Mireille
AU - Gertz, Morie A.
AU - Issa, Naim S.
AU - Kapoor, Prashant
AU - Kourelis, Taxiarchis
AU - Kukla, Aleksandra
AU - Kumar, Shaji
AU - Lacy, Martha Q.
AU - Lorenz, Elizabeth C.
AU - Muchtar, Eli
AU - Murray, David L.
AU - Nasr, Samih H.
AU - Prieto, Mikel
AU - Rajkumar, S. Vincent
AU - Schinstock, Carrie A.
AU - Stegall, Mark D.
AU - Warsame, Rahma
AU - Leung, Nelson
N1 - Funding Information:
Cihan Heybeli, MD, Mariam Priya Alexander, MD, Andrew Bentall, MB, ChB, MD, Hatem Amer, MD, Francis Buadi, MD, Patrick G. Dean, MD, David Dingli, MD, PhD, Angela Dispenzieri, MD, Mireille El Ters, MD, Morie A. Gertz, MD, Naim Issa, MD, Prashant Kapoor, MD, Taxiarchis Kourelis, MD, Aleksandra Kukla, MD, Shaji Kumar, MD, Martha Q. Lacy, MD, Elizabeth C. Lorenz, MD, Eli Muchtar, MD, David Murray, MD, PhD, Samih H. Nasr, MD, Mikel Prieto, MD, Vincent Rajkumar, MD, Carrie A. Schinstock, MD, Mark Stegall, MD, Rahma Warsame, MD, and Nelson Leung, MD. Research idea and study design: MPA, AB, NL, CH; data acquisition: CH; data analysis: CH, NL; data interpretation: all authors; statistical analysis: CH, NL; supervision and mentorship: NL. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. CH received a research grant from the Turkish Society of Nephrology, which did not have a role in study design, data collection, analysis, reporting, or the decision to submit for publication. Dr Dispenzieri reports ?other? from Alnylam, Intellia, and Janssen and grants from Takeda, Pfizer, Prothena, Celgene, Alnylam, and Janssen outside the submitted work; Dr Gertz reports personal fees from Ionis/Akcea, Alnylam, Prothena, Sanofi, Janssen, Annexon, Appellis, Amgen, Medscape, and Physicians Education Resource, grants and personal fees from Spectrum, personal fees for data safety monitoring board from Abbvie, Celgene personal fees from Research to Practice, speaker fees from Johnson & Johnson, Medscape, and DAVA oncology, Advisory Board for Pharmacyclics Advisory Board for Proclara outside the submitted work, and development of educational materials for i3Health outside the submitted work; Dr Kapoor reports grants from Amgen, Takeda, GSK, Sanofi, and AbbVie and personal fees from Cellectar, Pharmacyclics, Karyopharm, Sanofi, and GSK outside the submitted work; Dr Kumar reports grants and ?other? from Abbvie, Celgene, Janssen, Takeda, Adaptive, KITE, Medimmune/AstraZeneca, grants from Merck, Novartis, Roche, Sanofi, and ?other? from Oncopeptides outside the submitted work; Dr Leung reports ?other? from Takeda and AbbVie and personal fees from Aduro outside the submitted work; and Dr Murray has a patent on the use of mass spectrometry for plasma cell diseases licensed to The Binding Site. Original data may be requested from the corresponding author. Received December 24, 2020. Evaluated by 2 external peer reviewers, with direct editorial input from an Associate Editor and the Editor-in-Chief. Accepted in revised form April 16, 2021.
Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2021
Y1 - 2021
N2 - Rationale & Objective: Data on kidney transplantation outcomes among patients with monoclonal gammopathy of renal significance (MGRS) are lacking. Study Design: Case series of patients with MGRS, some of whom received clone-directed therapies before kidney transplantation. Setting & Participants: 28 patients who underwent kidney transplantation from 1987 through 2016 after diagnosis with MGRS-associated lesions including light-chain deposition disease (LCDD), C3 glomerulopathy with monoclonal gammopathy (C3G-MG), and light-chain proximal tubulopathy (LCPT). Findings: Of the 19 patients with LCDD, 10 were treated before kidney transplantation and 9 were treatment-naive. Among the treated patients with LCDD, 3 (30%) experienced histologic recurrence, 2 (20%) grafts failed, and 2 (20%) died during a median follow-up of 70 (range, 3-162) months after transplant. In the treatment-naive LCDD group, 8 (89%) had histologic recurrence, 6 (67%) grafts failed, and 4 (44%) patients died during a median follow-up of 60 (range, 35-117) months. Of the 5 patients who had a complete response before transplant, none died, and only 1 experienced graft failure, 162 months after transplant. Of 5 patients with C3G-MG, 3 were treatment-naive before transplant. Both patients who were treated before transplant had histologic recurrence, and 1 experienced graft failure and died. Among the 3 patients with treatment-naive C3G-MG, histologic recurrence occurred in all, and graft loss and death were observed in 2 and 1, respectively. In the LCPT group (n = 4), histologic recurrence was observed in all 3 patients who did not receive clone-directed therapies before transplant, and 2 of these patients died, 1 with a functioning kidney. The 1 patient with LCPT who received therapy before transplant did not have histologic recurrence or graft loss and survived. Limitations: Small sample size, nonstandardized clinical management, retrospective design. Conclusions: Recurrence is very common in all MGRS-associated lesions after kidney transplant. Achieving a complete hematologic response may reduce the risks of recurrence, graft loss, and death. More studies are needed to determine the effects of hematologic response on outcomes for each MGRS-associated lesion.
AB - Rationale & Objective: Data on kidney transplantation outcomes among patients with monoclonal gammopathy of renal significance (MGRS) are lacking. Study Design: Case series of patients with MGRS, some of whom received clone-directed therapies before kidney transplantation. Setting & Participants: 28 patients who underwent kidney transplantation from 1987 through 2016 after diagnosis with MGRS-associated lesions including light-chain deposition disease (LCDD), C3 glomerulopathy with monoclonal gammopathy (C3G-MG), and light-chain proximal tubulopathy (LCPT). Findings: Of the 19 patients with LCDD, 10 were treated before kidney transplantation and 9 were treatment-naive. Among the treated patients with LCDD, 3 (30%) experienced histologic recurrence, 2 (20%) grafts failed, and 2 (20%) died during a median follow-up of 70 (range, 3-162) months after transplant. In the treatment-naive LCDD group, 8 (89%) had histologic recurrence, 6 (67%) grafts failed, and 4 (44%) patients died during a median follow-up of 60 (range, 35-117) months. Of the 5 patients who had a complete response before transplant, none died, and only 1 experienced graft failure, 162 months after transplant. Of 5 patients with C3G-MG, 3 were treatment-naive before transplant. Both patients who were treated before transplant had histologic recurrence, and 1 experienced graft failure and died. Among the 3 patients with treatment-naive C3G-MG, histologic recurrence occurred in all, and graft loss and death were observed in 2 and 1, respectively. In the LCPT group (n = 4), histologic recurrence was observed in all 3 patients who did not receive clone-directed therapies before transplant, and 2 of these patients died, 1 with a functioning kidney. The 1 patient with LCPT who received therapy before transplant did not have histologic recurrence or graft loss and survived. Limitations: Small sample size, nonstandardized clinical management, retrospective design. Conclusions: Recurrence is very common in all MGRS-associated lesions after kidney transplant. Achieving a complete hematologic response may reduce the risks of recurrence, graft loss, and death. More studies are needed to determine the effects of hematologic response on outcomes for each MGRS-associated lesion.
KW - Monoclonal gammopathy of renal significance (MGRS)
KW - case series
KW - graft loss
KW - hematologic response
KW - kidney transplantation
KW - plasma cell disorder
KW - recurrence
KW - renal transplant
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U2 - 10.1053/j.ajkd.2021.04.015
DO - 10.1053/j.ajkd.2021.04.015
M3 - Article
C2 - 34175375
AN - SCOPUS:85114165933
VL - 79
SP - 202
EP - 216
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 2
ER -