Systematic Review of Kidney Transplant Outcomes in Monoclonal Ig Deposition Disease.
Pooling nearly ninety transplanted kidneys, this review found that outcomes in monoclonal immunoglobulin deposition disease are better than older reports suggested, with about two-thirds of grafts still working at five years. Achieving a good blood response before transplant, and treating the underlying plasma cell clone when the disease returns, were both linked to longer graft survival.
Background
Historical case series of monoclonal Ig deposition disease (MIDD) after kidney transplantation reported unfavourable outcomes, while more recent case series support more acceptable outcomes in selected patients. This review pooled the available individual participant data to resolve the discrepancy.
Study design
The authors performed a pooled analysis of case series and case reports with available individual participant data, searching MEDLINE, Web of Science, SCOPUS, the Cochrane Library and grey literature. Recurrence-free survival, graft survival and overall survival from the time of transplantation were analysed, with sensitivity analyses by publication type, pre-transplant haematologic response, exposure to novel agents and era.
Key findings
Eighty-seven kidney allografts from 1986 to 2023 were included. Over a median follow-up of 46 months, recurrence occurred in 47 allografts (54%) at a median of 30 months. Recurrence-free survival was significantly longer in patients achieving at least a very good partial response before transplantation. Graft survival was 67.1% at 5 years and 45.9% at 10 years, and overall survival was 83.8% and 47.4% at 5 and 10 years. Among patients with recurrence, median time from recurrence to graft failure was longer with clone-directed therapy (62 vs 11 months, P = 0.02).
Clinical implications
The authors conclude that contemporary outcomes of MIDD after kidney transplantation are favourable and that clone-directed therapy in recurrent disease appears to prolong graft survival.
Category
Transplant
Source
Kidney International Reports
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