肾移植后意义未明的单克隆丙种球蛋白病：单中心经验

Monoclonal Gammopathy of Undetermined Significance After Kidney Transplantation: Single-Center Experience.

作者信息

Alfano Gaetano, Fontana Francesco, Colaci Elisabetta, Messerotti Andrea, Bettelli Francesca, Potenza Leonardo, Luppi Mario, Cappelli Gianni

机构信息

1 Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy. 2 Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy. 3 Surgical, Medical and Dental Department of Morphological Sciences, Section of Hematology, University Hospital of Modena and Reggio Emilia, Modena, Italy.

出版信息

Transplantation. 2017 Nov;101(11):e337-e342. doi: 10.1097/TP.0000000000001884.

DOI:10.1097/TP.0000000000001884

PMID:28731904

Abstract

BACKGROUND

Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic premalignant plasma cell disorder. Prevalence and clinical outcomes of MGUS in kidney transplant (KT) recipients have been previously reported in few studies with conflicting results.

METHODS

We conducted a retrospective study in a population of 548 KT recipients transplanted between 1998 and 2015.

RESULTS

Thirty-nine (8.1%) subjects developed MGUS after KT. At diagnosis of MGUS, the average age was 52 ± 9.2 years, and 23% of the patients were younger than 50 years. Occurrence of MGUS was not influenced by age and sex. After a mean follow-up of 7.8 years, only 1 (2.5%) patient progressed to multiple myeloma. We found no differences in the incidence of solid and hematological malignancies, serious infections, graft failure, and mortality between KT patients with MGUS and a matched cohort of KT recipients without MGUS. The MGUS group had a significantly higher prevalence of monoclonal B cell lymphocytosis, premalignant condition poorly described in KT recipients. Prior history of glomerulonephritis or interstitial nephritis, as cause of renal failure, represented the only predictive factor for MGUS development.

CONCLUSIONS

MGUS is a premalignant disorder frequently encountered in KT recipients. We found no differences in clinical outcomes between MGUS patients and KT controls.

摘要

背景

意义未明的单克隆丙种球蛋白病（MGUS）是一种无症状的癌前浆细胞疾病。此前关于肾移植（KT）受者中MGUS的患病率和临床结局的研究较少，结果相互矛盾。

方法

我们对1998年至2015年间接受移植的548名KT受者进行了一项回顾性研究。

结果

39名（8.1%）受试者在KT后发生MGUS。在MGUS诊断时，平均年龄为52±9.2岁，23%的患者年龄小于50岁。MGUS的发生不受年龄和性别的影响。平均随访7.8年后，只有1名（2.5%）患者进展为多发性骨髓瘤。我们发现，有MGUS的KT患者与匹配的无MGUS的KT受者队列在实体和血液系统恶性肿瘤、严重感染、移植失败及死亡率方面无差异。MGUS组单克隆B细胞淋巴细胞增多症的患病率显著更高，这是一种在KT受者中描述较少的癌前状态。作为肾衰竭病因的既往肾小球肾炎或间质性肾炎病史是MGUS发生的唯一预测因素。