title: Neoplastic and non-neoplastic complications of solid organ transplantation in patients with preexisting monoclonal gammopathy of undetermined significance.
abstract: Monoclonal gammopathy of undetermined significance (MGUS) occurs in 3-7% of the elderly population, with higher prevalence in renal failure patients, and is associated with a 25-fold increased lifetime risk for plasma cell myeloma (PCM), also known as multiple myeloma. Using the California State Inpatient, Emergency Department, and Ambulatory Surgery Databases components of the Healthcare Cost and Utilization Project (HCUP), we sought to determine whether patients with MGUS who undergo solid organ allograft (n = 22,062) are at increased adjusted relative risk (aRR) for hematologic malignancy and other complications. Among solid organ transplant patients, patients with preexisting MGUS had higher aRR of PCM (aRR 19.46; 95% CI 7.05, 53.73; p < 0.001), venous thromboembolic events (aRR 1.66; 95% CI 1.15, 2.41; p = 0.007), and infection (aRR 1.24; 95% CI 1.06, 1.45; p = 0.007). However, when comparing MGUS patients with and without solid organ transplant, there was decreased aRR for PCM with transplant (aRR 0.34; 95% CI 0.13, 0.88; p = 0.027), and increased venous thromboembolic events (aRR 2.33; 95% CI 1.58, 3.44; p < 0.001) and infectious risks (aRR 1.44; 95% CI 1.23, 1.70; p < 0.001). While MGUS increased the risk of PCM overall following solid organ transplantation, there was lower risk of PCM development compared to MGUS patients who did not receive a transplant. MGUS should not preclude solid organ transplant.
authors.affiliation: Division of Hematology & Oncology, Department of Internal Medicine, Case Comprehensive Cancer Center & University Hospitals Seidman Cancer Center, Cleveland, OH, USA.
authors.forename: Teresa E
authors.initials: TE
authors.lastname: Goebel
authors.affiliation: Department of Epidemiology & Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.|Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Section of Transplant Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kenneth J
authors.identifier: http://orcid.org/0000-0002-7495-3758
authors.initials: KJ
authors.lastname: Woodside
authors.affiliation: Department of Epidemiology & Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.|Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA.
authors.forename: Aiswarya Chandran
authors.initials: AC
authors.lastname: Pillai
authors.affiliation: Division of Hematology & Oncology, Department of Internal Medicine, Case Comprehensive Cancer Center & University Hospitals Seidman Cancer Center, Cleveland, OH, USA.
authors.forename: Paolo F
authors.initials: PF
authors.lastname: Caimi
authors.affiliation: Division of Hematology & Oncology, Department of Internal Medicine, Case Comprehensive Cancer Center & University Hospitals Seidman Cancer Center, Cleveland, OH, USA.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Department of Epidemiology & Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.|Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA.
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.affiliation: Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Campagnaro
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications*; D009101:Multiple Myeloma / Q000209:etiology*; D016377:Organ Transplantation; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology*
keywords: Healthcare Cost and Utilization Project; monoclonal gammopathy of undetermined significance; multiple myeloma; plasma cell myeloma; post-transplant lymphoproliferative disorder; solid organ transplantation; venous thromboembolism