Can patients with CKD and dysproteinemias receive a kidney transplant?
Despite significant advances in diagnosis and chemotherapy, most patients with myeloma, amyloidosis, or LCDD are older and have significant comorbidity. Since the disease remains incurable with a high chance of recurrence, kidney transplant is rarely considered appropriate. A smaller group of younger patients with myeloma, after successful induction therapy and ASCT, may be considered suitable if prolonged disease remission (approximately 3 years) by standard criteria and if normalization of the sFLC ratio are achieved. In the absence of active LC myeloma, the risk of recurrent cast nephropathy is low. Surveillance after kidney transplant for disease recurrence is indefinite and would involve regular estimation of sFLC ratio because this is the most sensitive and specific marker of disease recurrence and provides an estimate of the risk of allograft injury. The results for LCDD suggest a very high risk of early and aggressive disease recurrence after kidney transplant in the absence of prolonged disease remission and ASCT. Rare cases of kidney transplantation in primary amyloidosis after chemotherapy and ASCT are also reported.
