Long-Term Outcome of Renal Transplantation in Light-Chain Deposition Disease

Nelson Leung, Donna J. Lager, Morie Gertz, Kirk Wilson, Sharan Kanakiriya, Fernando Custodio Fervenza

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Background: Light-chain deposition disease (LCDD) is a monoclonal gammopathy characterized by nonamyloid deposition of light chain in various organs. A small number of kidney transplantations have been performed on LCDD patients in whom end-stage renal disease (ESRD) developed. Methods: The authors retrospectively reviewed the clinical and histologic findings and outcome of 7 patients with LCDD who underwent kidney transplantation at our institution. Results: Renal insufficiency, hypertension, and proteinuria were present in all 7 patients. Proteinuria level was greater than 3.5 g/24 h in 3 patients. Three patients had microscopic hematuria. Monoclonal protein was detected in the serum in 3 patients, urine in 5, and was undetectable in 2. Median age at presentation was 42.7 (range, 33 to 58) years. The most common renal biopsy findings were mesangial expansion, mesangial nodules, tubular basement membrane thickening, and tubular atrophy. Kappa light chain was detected in all 7 renal biopsy results. Five patients were on dialysis before transplantation. LCDD recurred after a median of 33.3 (range, 2 to 45) months in 5 of the 7 patients. One patient remains on dialysis, whereas the other 4 have died. One patient died of progression of multiple myeloma 3 months after kidney transplantation without evidence of recurrence. Only 1 patient remains recurrence free after 13 years with normal renal allograft function. Conclusion: Although long-term benefits are occasionally seen, renal allograft survival is reduced significantly in LCDD patients. Kidney transplantation should not be an option for LCDD patients unless measures have been taken to reduce light chain production.

Original languageEnglish (US)
Pages (from-to)147-153
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume43
Issue number1
DOIs
StatePublished - Jan 2004

Fingerprint

Kidney Transplantation
Light
Kidney
Proteinuria
Allografts
Dialysis
Biopsy
Recurrence
Paraproteinemias
Renal Hypertension
Hematuria
Multiple Myeloma
Basement Membrane
Chronic Kidney Failure
Atrophy
Renal Insufficiency
Transplantation
Urine

Keywords

  • Kidney transplantation
  • Light-chain deposition disease (LCDD)
  • Monoclonal gammopathy

ASJC Scopus subject areas

  • Nephrology

Cite this

Long-Term Outcome of Renal Transplantation in Light-Chain Deposition Disease. / Leung, Nelson; Lager, Donna J.; Gertz, Morie; Wilson, Kirk; Kanakiriya, Sharan; Fervenza, Fernando Custodio.

In: American Journal of Kidney Diseases, Vol. 43, No. 1, 01.2004, p. 147-153.

Research output: Contribution to journalArticle

Leung, Nelson ; Lager, Donna J. ; Gertz, Morie ; Wilson, Kirk ; Kanakiriya, Sharan ; Fervenza, Fernando Custodio. / Long-Term Outcome of Renal Transplantation in Light-Chain Deposition Disease. In: American Journal of Kidney Diseases. 2004 ; Vol. 43, No. 1. pp. 147-153.
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