Long-term outcome of kidney transplantation in AL amyloidosis

A study from The Mayo Clinic evaluated long-term outcomes of kidney transplantation in patients with immunoglobulin light chain amyloidosis

“…25 A median patient survival of 10.5 years after kidney transplantation was reported in a larger study comprised of 49 patients with a 5-year graft survival of 89%. 26 Similar results were reported in 16 patients with an estimated median allograft survival of 136 months after median of 41 months of follow-up. 27 We had previously reported on the outcomes of 19 patients with AL amyloidosis following kidney transplantation.…”

The impact and importance of achieving a complete haematological response prior to renal transplantation in AL amyloidosis

“…Renal transplantation is associated with lower mortality, less risk of cardiovascular events and improved quality of life when compared to RRT 3 . In 2010, we reported a median overall survival (OS) of 6.5 years and median graft survival of 5.8 years 4 in patients with AL amyloidosis who underwent renal transplantation, whilst a recent report from the Boston group documented an impressive 10.5 year OS and 8.3-year graft survival 5 , perhaps reflecting advances in patient selection and available therapies over the last decade. Appropriate patient selection is imperative from the perspective of both fitness to undergo transplantation and depth of HR.…”

Kidney transplantation in AL Amyloidosis: is it time to maximize access?

“…Small series have described patients with AL amyloidosis and advanced kidney disease transplanted prior to and following plasma cell‐directed therapy (Herrmann et al , ). A recent series of AL amyloidosis patients undergoing kidney transplant showed reduced risk of amyloid recurrence in the grafts of patients in CR/VGPR at the time of kidney transplantation compared to patients in PR/non‐response (Angel‐Korman et al , ). However, all patients had excellent outcomes.…”

“…With the availability of directed‐donor and exchange programmes, access to organs for transplantation has grown substantially. If the light chain burden is low but not necessarily undetectable and a suitable donor is available, consideration should be given to proceed with kidney transplantation rather than wait for VGPR/CR, given that RRT not only significantly impacts patients’ QOL and OS, but limits use of salvage therapy (Angel‐Korman et al , ).…”