Kidney Transplantation in Patients With Monoclonal Gammopathy of Renal Significance (MGRS)–Associated Lesions: A Case Series

Cihan Heybeli, Mariam Priya Alexander, Andrew J. Bentall, Hatem Amer, Francis K. Buadi, Patrick G. Dean, David Dingli, Angela Dispenzieri, Mireille El Ters, Morie A. Gertz, Naim S. Issa, Prashant Kapoor, Taxiarchis Kourelis, Aleksandra Kukla, Shaji Kumar, Martha Q. Lacy, Elizabeth C. Lorenz, Eli Muchtar, David L. Murray, Samih H. NasrMikel Prieto, S. Vincent Rajkumar, Carrie A. Schinstock, Mark D. Stegall, Rahma Warsame, Nelson Leung

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)202-216
Number of pages15
JournalAmerican Journal of Kidney Diseases
Volume79
Issue number2
DOIs
StateAccepted/In press - 2021

Keywords

  • Monoclonal gammopathy of renal significance (MGRS)
  • case series
  • graft loss
  • hematologic response
  • kidney transplantation
  • plasma cell disorder
  • recurrence
  • renal transplant

ASJC Scopus subject areas

  • Nephrology

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