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Monoclonal Gammopathies After Renal Transplantation: A Single-center Study
Bhavna Bhasin1, Aniko Szabo2, Ruizhe Wu2
1Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI.
Introduction:
Plasma cell disorders (PCDs) are clonal plasma cell disorders that include conditions such as monoclonal gammopathy of undetermined significance (MGUS), monoclonal gammopathy of renal significance (MGRS), multiple myeloma (MM), smoldering MM (SMM), solitary plasmacytoma, and light-chain (AL) amyloidosis. The risk factors associated with and the clinical course of PCDs after renal transplantation is not well established although immunosuppressive protocols may impact the incidence and natural history of PCDs posttransplant.
Patients And Methods:
This single-center retrospective study evaluated patients with a history of renal transplant who developed a PCD between January 1, 2014-December 31, 2018.
Result:
A total of 41 patients met the inclusion criteria including 29 with MGUS and 12 with symptomatic PCD (4 with MM, 2 with SMM, 4 with MGRS, 1 with AL amyloidosis, and 1 with solitary plasmacytoma). The median follow-up of survivors was 41.6 months. Three patients (1 with MGUS and 2 with MGRS) progressed to MM during the follow-up period. There was a male preponderance in both groups. There was no correlation between the donor and immunosuppressive regimen and the development of a PCD. Patients with symptomatic PCD had higher serum creatinine and M-protein levels at diagnosis and higher free light chain ratio and plasma cell burden. There was also a higher percentage of allograft failure noted in the symptomatic PCD subset 50% (n = 6), whereas only 23% (n = 7) of patients had allograft failure in the MGUS group.
Conclusion:
This study shows the importance of considering monoclonal gammopathy in the differential of renal dysfunction after kidney transplant and the need to follow these patients closely to monitor for progression to symptomatic PCD.
Insights
Plasma cell disorders (PCDs) can occur after kidney transplants. Close monitoring is crucial as some patients with monoclonal gammopathy of undetermined significance (MGUS) may progress to symptomatic PCD, impacting allograft survival.
Area of Science:
- Nephrology
- Hematology
- Immunology
Background:
- Plasma cell disorders (PCDs) encompass a range of conditions including monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma (MM), and AL amyloidosis.
- The incidence and clinical course of PCDs following renal transplantation are not well understood, with potential influence from immunosuppressive therapies.
Purpose of the Study:
- To evaluate the development and progression of PCDs in patients with a history of renal transplantation.
- To assess the relationship between PCDs and allograft outcomes in transplant recipients.
Main Methods:
- A single-center retrospective study was conducted.
- Patients who developed a PCD after renal transplantation between January 1, 2014, and December 31, 2018, were included.
- Data on patient demographics, PCD type, immunosuppression, and allograft outcomes were analyzed.
Main Results:
- Of 41 patients, 29 had MGUS and 12 had symptomatic PCD (including MM, smoldering MM, MGRS, AL amyloidosis, solitary plasmacytoma).
- Three patients progressed to MM during follow-up. Symptomatic PCD was associated with higher creatinine, M-protein levels, and plasma cell burden.
- Allograft failure occurred in 50% of symptomatic PCD patients versus 23% of MGUS patients.
Conclusions:
- Monoclonal gammopathy should be considered in the differential diagnosis of renal dysfunction post-transplant.
- Close patient follow-up is essential to detect progression to symptomatic PCD and manage potential allograft complications.
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