Dykes Kaitlyn, Desale Sameer, Javaid Basit, Miatlovich Krystsina, Kessler Craig
MedStar Georgetown University Hospital Internal Medicine, Washington, DC.
Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Hyattsville, MD.
Clin Lymphoma Myeloma Leuk. 2022 May;22(5):e314-e320. doi: 10.1016/j.clml.2021.11.002. Epub 2021 Nov 11.
Describe graft and overall survival outcomes in multiple myeloma (MM) patients who underwent kidney transplant (KT) compared to the general KT population.
The Organ Procurement and Transplantation Network/National United Network for Organ Sharing (OPTON/UNOS) database was analyzed from 1988 to 2019 with R 4.00 and the 2013-2017 United States Renal Data System (USRDS) was surveyed for incidence and mortality of MM ESRD.
USRDS analysis revealed 961 patients diagnosed with ESRD due to MM on average annually, accounting for 0.8% of the ESRD population. Without KT, 44.4% of MM patients died in the first year of renal replacement initiation. OPTON/UNOS analysis identified 218 MM KT patients, compared to 490,089 patients without MM. There was no difference in graft survival between MM KT and the general population (P-value = .13, HR = 1.19 [0.95, 1.49], 95% CI). Median graft survival in MM KT was 2683 days (7.4 years). KT patients with MM had a higher risk for death (P-value = <.0001, HR = 1.83 [1.41, 2.37], 95% CI), and median overall survival was 3076 days (8.4 years). Survival difference was lost when comparing patients ≥50 years (P-value = .42, HR = 1.14 [0.83, 1.56], 95% CI).
Patients with MM renal failure who underwent KT had equivalent graft and age-matched overall survival compared to the general KT population. Therefore select patients with MM renal failure have potential for excellent KT outcomes, should be considered for transplantation when feasible, and should not be excluded from KT based on a history of MM.
描述接受肾移植（KT）的多发性骨髓瘤（MM）患者与一般KT人群相比的移植物和总体生存结果。
使用R 4.00对1988年至2019年的器官获取与移植网络/全国器官共享联合网络（OPTN/UNOS）数据库进行分析，并对2013 - 2017年美国肾脏数据系统（USRDS）进行MM终末期肾病（ESRD）发病率和死亡率调查。
USRDS分析显示，平均每年有961例患者因MM被诊断为ESRD，占ESRD人群的0.8%。未进行KT时，44.4%的MM患者在开始肾脏替代治疗的第一年死亡。OPTN/UNOS分析确定了218例MM KT患者，与490,089例非MM患者相比。MM KT患者与一般人群的移植物存活率无差异（P值 = 0.13，风险比[HR] = 1.19[0.95, 1.49]，95%置信区间[CI]）。MM KT患者的移植物中位存活时间为2683天（7.4年）。患有MM的KT患者死亡风险更高（P值 = <0.0001，HR = 1.83[1.41, 2.37]，95% CI），总体中位生存时间为3076天（8.4年）。在比较≥50岁的患者时，生存差异消失（P值 = 0.42，HR = 1.14[0.83, 1.56]，95% CI）。
接受KT的MM肾衰竭患者与一般KT人群相比，移植物和年龄匹配的总体生存率相当。因此，选择合适的MM肾衰竭患者有可能获得良好的KT结果，在可行时应考虑进行移植，且不应因MM病史而被排除在KT之外。
