Renal transplantation in amyloid nephropathy

Area of Science:

• Nephrology
• Immunology
• Rheumatology

Background:

• AA-type amyloidosis is a systemic inflammatory disease that can lead to end-stage renal disease.
• Renal transplantation is a potential treatment option for patients with end-stage renal disease due to AA-type amyloidosis.

Observation:

• Two patients with end-stage renal disease due to AA-type amyloidosis underwent renal transplantation.
• One patient with rheumatoid arthritis-associated amyloidosis experienced graft amyloid deposition and died from cardiogenic shock 12 months post-transplant.
• The second patient with familial Mediterranean fever-associated amyloid nephropathy maintained excellent graft function 24 months post-transplant.

Findings:

• In a review of 33 cases (including the 2 presented), proteinuria was reported in 32.3% of patients.
• Amyloid deposition was detected in functioning grafts in 41.4% of cases.
• Graft function remained excellent even with the presence of small amyloid deposits.

Implications:

• Renal transplantation can be a successful treatment for AA-type amyloid nephropathy.
• Careful patient selection is crucial, excluding those with life-threatening amyloid involvement of other organs.
• Further research is needed to understand the long-term outcomes and management of amyloid deposition in renal grafts.