Long-term outcome of live donor kidney transplantation for renal amyloidosis.
BACKGROUND
The short-term outcome of kidney transplantation in patients with amyloidosis has been reported. The aim of this study is to investigate long-term results in patients with renal amyloidosis.


METHODS
We studied results of renal transplantation in 23 amyloidotic transplant recipients compared with those in a control group of 47 nonamyloidotic patients. Amyloidosis was secondary to familial Mediterranean fever (FMF) in 16 patients, whereas it was primary (idiopathic) in 7 transplant recipients. The 2 groups were homogeneous regarding age, sex, HLA matching, immunosuppression, and duration of transplantation.


RESULTS
Five- and 10-year actuarial graft survival rates were similar in both groups (79.35% versus 84.04% and 65.92% versus 56.61%, respectively ). Five- and 10-year actuarial patient survival rates also were similar (80% versus 94% and 68% versus 87%, respectively). Moreover, 72.4% of controls experienced at least 1 rejection episode, whereas only 43.5% of amyloidotic transplant recipients experienced 1 or more such events (P = 0.02). Nonetheless, mean serum creatinine concentrations did not differ between the 2 groups during the observation period. Maintenance colchicine therapy prevented the recurrence of both FMF symptoms and amyloidosis. Recurrence was documented in only 1 amyloidotic transplant recipient (4.3%) 10 years posttransplantation. Significant gastrointestinal (GI) problems were more frequent in amyloidotic patients (65% versus 38%; P = 0.03). Amyloidotic patients with GI problems, except for 2 patients, were administered cyclosporine. Eleven of these patients had FMF, which appeared to reflect the effects of both cyclosporine and colchicine. Infections were similar in the groups; whereas amyloidotic patients had significantly lower blood pressures.


CONCLUSIONS
In our experience, long-term (5 to 10 years) outcome of live related donor kidney transplantation in patients with amyloidosis is similar to that in the general transplant population.
Sherif
Ali Mohamed
AM
Urology and Nephrology Center, Mansoura, Egypt.
Refaie
Ayman Fathi
AF
Sobh
Mohamed Abdel-Kader
MA
Mohamed
Nagi Abdel-Hadi
NA
Sheashaa
Hussein Atia
HA
Ghoneim
Mohamed Ahmed
MA
D000293:Adolescent; D000328:Adult; D000686:Amyloidosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D016572:Cyclosporine / Q000627:therapeutic use; D010505:Familial Mediterranean Fever / Q000150:complications / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine