title: Acute Kidney Allograft Rejection Precipitated by Lenalidomide Treatment for Multiple Myeloma.
abstract: Patients who develop malignancy after kidney transplantation typically undergo a reduction in immunosuppression and referral to an oncologist for chemotherapeutic considerations for the management of their malignancy. Traditional cytotoxic chemotherapy agents can result in kidney transplant injury, but the decision about which agents to be used has largely been determined by oncologists without the involvement of nephrologists. More recently, several classes of drugs with immunomodulatory actions have been approved for the treatment of cancer, including multiple myeloma. Activation of the immune system against malignant cells may have unintended consequences in solid-organ transplant recipients, who require suppression of the immune system to avoid transplant rejection. In this report, we present a case of acute kidney transplant rejection in a 65-year-old woman following administration of the newer immunomodulatory agent lenalidomide for the treatment of multiple myeloma. A greater awareness of the mechanisms of newly introduced chemotherapy agents and discussion with the treating oncologist and patient are paramount in caring for patients who develop malignancy following transplantation.
authors.affiliation: Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: elum@mednet.ucla.edu.
authors.forename: Erik L
authors.initials: EL
authors.lastname: Lum
authors.affiliation: Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Edmund
authors.initials: E
authors.lastname: Huang
authors.affiliation: Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
authors.affiliation: Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Thu
authors.initials: T
authors.lastname: Pham
authors.affiliation: Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Danovitch
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000069340:Deprescriptions; D005260:Female; D006084:Graft Rejection / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D000077269:Lenalidomide; D060046:Maintenance Chemotherapy; D009101:Multiple Myeloma / Q000188:drug therapy*; D009173:Mycophenolic Acid / Q000627:therapeutic use; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery*; D016559:Tacrolimus / Q000627:therapeutic use; D013792:Thalidomide / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000305:Adrenal Cortex Hormones; D000961:Antilymphocyte Serum; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D013792:Thalidomide; D000077269:Lenalidomide; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: Kidney allograft rejection; acute renal allograft rejection; case report; chemotherapy regimen; immunomodulatory chemotherapy agent; immunosuppression withdrawal; kidney transplant; lenalidomide; malignancy; multiple myeloma