Solid organ transplantation in AL amyloidosis

Area of Science:

• Nephrology
• Cardiology
• Hepatology
• Hematology

Background:

• AL amyloidosis frequently causes vital organ failure, making solid organ transplantation a complex consideration due to the disease's multisystemic nature and potential for graft recurrence.
• Solid organ transplantation in AL amyloidosis patients is rare due to disease complexity and recurrence risks.

Purpose of the Study:

• To evaluate the outcomes of solid organ transplantation in patients with AL amyloidosis.
• To assess the feasibility and long-term results of renal, cardiac, and liver transplantation in AL amyloidosis.

Main Methods:

• Retrospective analysis of AL amyloidosis patients who underwent solid organ transplantation at the UK National Amyloidosis Centre between 1984 and 2009.
• Data collection included patient survival, graft survival, and recurrence of amyloidosis post-transplantation.

Main Results:

• One and 5-year survival rates were 95%/67% for kidney, 86%/45% for heart, and 33%/22% for liver transplant recipients.
• No renal graft failures were attributed to recurrent amyloidosis during a median follow-up of 4.8 years.
• Cardiac transplant recipients who subsequently underwent stem cell transplantation (SCT) had longer median survival (9.7 years) compared to those without SCT (3.4 years). Amyloid was widespread in all liver transplant recipients.

Conclusions:

• Solid organ transplantation, particularly kidney and heart, can be a feasible option for selected AL amyloidosis patients with organ failure.
• Stem cell transplantation following cardiac transplant may improve long-term survival in AL amyloidosis.
• Liver transplantation in AL amyloidosis carries a high risk due to widespread amyloid infiltration.