Risk factors for amyloidosis and impact of kidney transplantation on the course of familial Mediterranean fever.
BACKGROUND
Amyloidosis of familial Mediterranean fever (FMF) may lead to end-stage renal failure, culminating in kidney transplantation in some patients.


OBJECTIVE
To assess demographic, clinical and genetic risk factors for the development of FMF amyloidosis in a subset of kidney-transplanted patients and to evaluate the impact of transplantation on the FMF course.


METHODS
Demographic, clinical and genetic data were abstracted from the files, interviews and examinations of 16 kidney-transplanted FMF amyloidosis patients and compared with the data of 18 FMF patients without amyloidosis.


RESULTS
Age at disease onset and clinical severity of the FMF amyloidosis patients prior to transplantation were similar to FMF patients without amyloidosis. Compliance with colchicine treatment, however, was much lower (50% vs. 98%). Posttransplantation, FMF amyloidosis patients experienced fewer of the typical serosal attacks than did their counterparts (mean 2214 days since last attack vs. 143 days). Patients with FMF amyloidosis carried only M694V mutations in the FMF gene, while FMF without amyloidosis featured other mutations as well.


CONCLUSIONS
Compliance with treatment and genetic makeup but not severity of FMF constitutes major risk factors for the development of amyloidosis in FMF. Transplantation seems to prevent FMF attacks. The protective role of immunosuppressive therapy cannot be excluded.
Rheumatology Unit, Zabludowicz Center of Autoimmune Disease, Tel Hashomer, Israel.
Ilan
I
Ben-Zvi
Iveta
I
Danilesko
Gilad
G
Yahalom
Olesya
O
Kukuy
Ruth
R
Rahamimov
Avi
A
Livneh
Shaye
S
Kivity
D000328:Adult; D000686:Amyloidosis / Q000209:etiology* / Q000601:surgery; D016022:Case-Control Studies; D003078:Colchicine / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003598:Cytoskeletal Proteins / Q000235:genetics; D005006:Ethnicity; D010505:Familial Mediterranean Fever / Q000150:complications* / Q000235:genetics*; D005260:Female; D006720:Homozygote; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000209:etiology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009154:Mutation; D000071198:Pyrin; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016903:Drug Monitoring
D003598:Cytoskeletal Proteins; D007166:Immunosuppressive Agents; C000604192:MEFV protein, human; D000071198:Pyrin; D003078:Colchicine