Leung Nelson, Heybeli Cihan
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Division of Hematology, Mayo Clinic, Rochester, MN.
Division of Nephrology, Dokuz Eylül University Hospital, Balcova, Turkey.
Semin Nephrol. 2024 Jan;44(1):151497. doi: 10.1016/j.semnephrol.2024.151497. Epub 2024 Mar 13.
Recent advances in the treatment of plasma cell disorders (PCDs) have provided a wealth of therapy alternatives and improved overall survival tremendously. Various types of PCDs are associated with kidney injury and end-stage kidney disease in a considerable number of patients. Kidney transplantation (KTx) is the best option for renal replacement therapy in select patients in terms of both quality of life parameters and overall survival. Even with modern therapies, all PCDs carry the risk of hematologic progression, whereas histologic recurrence and graft loss are other prevailing concerns in these patients. The risk of mortality is also higher in some of these disorders compared with KTx recipients who suffer from other causes of kidney disease. Unlike solid cancers, there is no well-defined "waiting time" after hematologic remission before proceeding to KTx. Thus, clinicians are usually reluctant to recommend KTx to patients who develop end-stage kidney disease due to PCDs. This review aims to provide the current evidence on KTx outcomes in patients with monoclonal gammopathy of renal significance and multiple myeloma. Although immunoglobulin light chain amyloidosis is a monoclonal gammopathy of renal significance subtype, KTx outcomes in this group are mentioned in another chapter of this issue.
浆细胞疾病（PCDs）治疗方面的最新进展提供了丰富的治疗选择，并极大地提高了总体生存率。相当多的患者中，各种类型的PCDs与肾损伤和终末期肾病相关。就生活质量参数和总体生存率而言，肾移植（KTx）是特定患者进行肾脏替代治疗的最佳选择。即使采用现代疗法，所有PCDs都有血液学进展的风险，而组织学复发和移植物丢失是这些患者中其他普遍存在的问题。与因其他肾脏疾病病因接受KTx的受者相比，某些此类疾病的死亡风险也更高。与实体癌不同，血液学缓解后进行KTx之前没有明确的“等待时间”。因此，临床医生通常不愿意向因PCDs发展为终末期肾病的患者推荐KTx。本综述旨在提供有关具有肾意义的单克隆丙种球蛋白病和多发性骨髓瘤患者KTx结局的当前证据。尽管免疫球蛋白轻链淀粉样变性是具有肾意义的单克隆丙种球蛋白病亚型，但该组患者的KTx结局在本期的另一章中提及。
