Management recommendations for kidney transplantation in patients with plasma cell dyscrasia.
A multidisciplinary panel concludes that kidney transplantation remains underused in patients with plasma cell dyscrasia despite modern therapies that are improving survival and widening transplant eligibility.
Background
Patients with plasma cell dyscrasia — including multiple myeloma, AL amyloidosis, and monoclonal gammopathy of renal significance — carry a high burden of end-stage kidney disease, which limits both survival and quality of life. Although kidney transplantation offers potential benefit in this population, it remains underused because of the high risk of disease recurrence in the allograft and historically poor post-transplant outcomes.
Study design
A multidisciplinary panel of transplant nephrologists, hematologists/oncologists, and pathologists convened to evaluate contemporary evidence and evolving strategies for kidney transplantation in patients with plasma cell dyscrasia and end-stage kidney disease. The output is a set of management recommendations rather than a trial or a cohort analysis, so its conclusions reflect expert appraisal of the existing literature.
Key findings
Advances in plasma cell dyscrasia therapies are improving survival and, in doing so, expanding the pool of patients who may be eligible for kidney transplantation. Key challenges nonetheless remain: optimizing the hematologic response before transplantation, and managing immunosuppression in a way that mitigates recurrence without incurring infectious complications.
Clinical implications
The panel emphasizes that ongoing research and multidisciplinary collaboration are essential to refine transplant candidate selection, integrate biomarkers for risk stratification, and develop tailored post-transplant surveillance. These efforts may increase access to kidney transplantation and improve outcomes for patients with plasma cell dyscrasia and end-stage kidney disease.
Category
Transplant
Source
Kidney Int
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.