Management recommendations for kidney transplantation in patients with plasma cell dyscrasia

Patients with plasma cell dyscrasia, including multiple myeloma, AL amyloidosis, and monoclonal gammopathy of renal significance, face a high burden of end-stage kidney disease, which limits survival and quality of life. Although kidney transplant offers potential benefits, it remains underused because of the high risk of recurrence and historically poor outcomes. A multidisciplinary panel of transplant nephrologists, hematologists/oncologists, and pathologists convened to evaluate contemporary evidence and evolving strategies in kidney transplant for plasma cell dyscrasias and end-stage kidney disease. Advances in plasma cell dyscrasia therapies are improving survival and expanding kidney transplant eligibility. However, key challenges remain, including optimizing hematologic response pre-kidney transplant and managing immunosuppression to mitigate recurrence and avoid infection complications. Ongoing research and multidisciplinary collaboration are essential to refine transplant selection, integrate biomarkers for risk stratification, and develop tailored post-kidney transplant surveillance. These efforts may increase access to kidney transplant and improve outcomes for patients with plasma cell dyscrasia and end-stage kidney disease.