Long-term outcomes of patients with light chain amyloidosis (AL) after renal transplantation with or without stem cell transplantation

Background. Recent advances in the treatment of immunoglobulin light chain amyloidosis (AL) have dramatically improved survival. Kidney transplantation (KTx) has become more common but the long-term outcomes remain unknown and it is the objective of this study.Methods. Nineteen patients with AL underwent living (n = 18) or deceased (n = 1) KTx at our institution from 1999 to 2008 (median age 57 years, six women). The primary end points were patient and kidney allograft survival and recurrence of AL in the allograft. The secondary end point was kidney transplant rejection. Outcome data were stratified according to three treatment modalities: renal transplantation followed by autologous stem cell transplantation (ASCT) (Group 1, n = 8), ASCT followed by renal transplantation (Group 2, n = 6) and renal transplantation after complete remission achieved with nonmyeloablative therapy (Group 3, n = 5).Results. The median follow-up was 41.4 months. At the time of study, 79% were still alive. Median graft survival did not differ from median overall survival. There was no difference in survival rates between the treatment groups. Five patients had a cellular rejection. Two of the three patients with a rejection in Group 1 died but neither patient with rejection in Groups 2 and 3. Recurrent amyloidosis was diagnosed by biopsy in one patient in Group 2 (preceding ASCT) and in another patient in Group 3.Conclusions. KTx can be successfully performed in AL patients in complete hematologic response and meet the usual KTx selection criteria. Outcomes appear similar whether hematologic response was achieved with ASCT or by nonmyeloablative therapy.