Department of Medicine, Division of Nephrology, University of California, San Francisco, California, USA.
Department of Medicine, Kidney Transplant Service, University of California, San Francisco, California, USA.
Clin Transplant. 2022 Mar;36(3):e14541. doi: 10.1111/ctr.14541. Epub 2021 Nov 30.
Transplant centers have historically been reluctant to proceed with kidney transplantation in individuals with plasma cell dyscrasias (PCDs) due to concern for high rates of PCD recurrence and PCD-related mortality. As novel therapies for PCDs have improved hematologic outcomes, strategies to optimize kidney transplantation in individuals with PCD-mediated kidney disease are needed. In this single-center case series we discuss our protocol for the transplantation of individuals with ESKD attributed to PCD as well as the hematologic and allograft outcomes of 12 kidney transplant recipients with ESKD attributed to PCD. Median follow-up time after kidney transplantation was 44 months (IQR 36, 84). All patients had a functioning allograft 1 year after kidney transplantation. 9/12 patients were alive and had a functioning allograft 5 years after kidney transplantation. Five patients experienced relapse of PCD (of whom three responded well to subsequent therapies) and four patients developed secondary malignancies, including three patients with urologic malignancies. This case series demonstrates that patients with kidney disease attributed to PCD have favorable outcomes with kidney transplantation. Transplant evaluation in patients with PCDs should involve a multidisciplinary team of transplant nephrologists and oncologists to select appropriate candidates. Providers should consider screening for urologic malignancies pre- and post-transplantation.
移植中心由于担心浆细胞异常（PCD）的高复发率和与 PCD 相关的死亡率，历史上一直不愿意对 PCD 患者进行肾移植。由于治疗 PCD 的新疗法改善了血液学结果，因此需要制定策略来优化 PCD 引起的肾脏疾病患者的肾移植。在这项单中心病例系列研究中，我们讨论了我们用于移植 PCD 引起的终末期肾病（ESKD）患者的方案，以及 12 名 PCD 引起的 ESKD 患者肾移植后的血液学和移植物结果。肾移植后中位随访时间为 44 个月（IQR 36，84）。所有患者在肾移植后 1 年均有功能正常的移植物。肾移植后 5 年，9/12 名患者存活且移植物功能正常。5 名患者出现 PCD 复发（其中 3 名对后续治疗反应良好），4 名患者发生继发性恶性肿瘤，包括 3 名泌尿系统恶性肿瘤患者。该病例系列研究表明，PCD 引起的肾病患者进行肾移植后有良好的结局。PCD 患者的移植评估应涉及移植肾脏病专家和肿瘤专家的多学科团队，以选择合适的候选者。提供者应考虑在移植前后筛查泌尿系统恶性肿瘤。
