Kidney Transplantation for Kidney Failure Due to Multiple Myeloma: Case Reports.
Transplantation centers have historically considered a history of multiple myeloma as a contraindication to kidney transplantation due to high recurrence rates and poor transplant survival. However, there have been significant advances in the treatment of multiple myeloma, with improved patient survival, which may allow for successful kidney transplantation in these patients. We report on 4 patients who underwent kidney transplantation at our institution between 2009 and 2015 after having achieved a very good partial response or better with chemotherapy and autologous stem cell transplantation. All 4 patients received kidneys from living donors; 2 underwent induction therapy with basiliximab, and 2, with thymoglobulin. One patient had progression of myeloma, which responded well to therapy. All had functioning transplants at 1 year after kidney transplantation. No patients experienced a rejection episode or infections with BK polyomavirus or cytomegalovirus, with follow-up ranging from 16 to 58 months after kidney transplantation. Our experience suggests that kidney transplantation is feasible in a subset of patients with multiple myeloma. Future studies are necessary to compare outcomes in these patients with other high-risk patients undergoing kidney transplantation.
Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Kidney Transplant Service, University of California, San Francisco, San Francisco, CA. Electronic address: thuy.le2@ucsf.edu.
Thuy X
TX
Le
Division of Hematology and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Jeffrey L
JL
Wolf
Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Kidney Health Research Collaborative, University of California, San Francisco, San Francisco, CA.
Carmen A
CA
Peralta
Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Kidney Transplant Service, University of California, San Francisco, San Francisco, CA.
Allison B
AB
Webber
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000378:metabolism; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D012074:Remission Induction; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous
D000970:Antineoplastic Agents; D007145:Immunoglobulin kappa-Chains; D007166:Immunosuppressive Agents
Kidney transplantation; RRT modality; autologous stem cell transplantation (ASCT); bortezomib; case report; end-stage renal disease (ESRD); hematologic malignancy; kidney failure; light chain deposition disease (LCDD); multiple myeloma; outcomes; remission; renal replacement therapy (RRT)