Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA.
Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
Nephrol Dial Transplant. 2022 Nov 23;37(12):2569-2580. doi: 10.1093/ndt/gfac196.
Recent improvement in treatment and patient survival has opened the eligibility of kidney transplantation to patients who developed end-stage kidney disease (ESKD) from plasma cell dyscrasias (PCDs). Data on clinical outcomes in this population are lacking.
We conducted a retrospective study of United Network for Organ Sharing/Organ Procurement and Transplantation Network dataset (2006-2018) to compare patient and graft outcomes of kidney transplant recipients with ESKD due to PCD versus other causes.
Among 168 369 adult first kidney transplant recipients, 0.22-0.43% per year had PCD as the cause of ESKD. The PCD group had worse survival than the non-PCD group for both living and deceased donor types {adjusted hazard ratio [aHR] 2.24 [95% confidence interval (CI) 1.67-2.99] and aHR 1.40 [95% CI 1.08-1.83], respectively}. The PCD group had worse survival than the diabetes group, but only among living donors [aHR 1.87 (95% CI 1.37-2.53) versus aHR 1.16 (95% CI 0.89-1.2)]. Graft survival in patients with PCD were worse than non-PCD in both living and deceased donors [aHR 1.72 (95% CI 1.91-2.56) and aHR 1.30 (95% CI 1.03-1.66)]. Patient and graft survival were worse in amyloidosis but not statistically different in multiple myeloma compared with the non-PCD group.
The study data are crucial when determining kidney transplant eligibility and when discussing transplant risks in patients with PCD.
治疗方法的进步和患者存活率的提高使得多发性骨髓瘤等浆细胞疾病导致的终末期肾病患者符合接受肾移植的条件。但目前此类患者的临床预后数据有限。
我们对 2006 年至 2018 年间美国器官共享联合网络/器官获取和移植网络（UNOS/OPTN）数据库进行了回顾性研究，比较了浆细胞疾病导致的终末期肾病患者和其他病因导致的终末期肾病患者的肾移植患者和移植物的预后。
在 168369 例成年首次肾移植受者中，每年有 0.22%至 0.43%的患者因浆细胞疾病而导致终末期肾病。浆细胞疾病组的受者无论接受活体供肾还是尸肾移植，其生存率均低于非浆细胞疾病组[调整后的风险比（aHR）分别为 2.24（95%可信区间[CI]：1.67-2.99）和 1.40（95%CI：1.08-1.83）]。浆细胞疾病组的受者生存率低于糖尿病组，但仅在活体供肾受者中低于糖尿病组[aHR 1.87（95%CI：1.37-2.53）比 aHR 1.16（95%CI：0.89-1.2）]。浆细胞疾病组接受活体供肾和尸肾移植的受者的移植物存活率均低于非浆细胞疾病组[aHR 1.72（95%CI：1.91-2.56）和 aHR 1.30（95%CI：1.03-1.66）]。淀粉样变性患者的患者和移植物存活率较差，但与非浆细胞疾病组相比，多发性骨髓瘤患者并无统计学差异。
本研究数据对于确定肾移植的适应证以及讨论浆细胞疾病患者的移植风险至关重要。
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