There is a nice recent review of the role of kidney
transplantation in patients with paraproteniemic renal disease (or plasma cell
dyscrasia kidney disease or PCD) from the UK published in Nephron Clinical Practice - available open access.
“For
patients with PCD it has generally been judged that transplantation is unlikely
to be of benefit. Disease recurrence affecting the renal allograft, increased
infection susceptibility and poor prognosis have been major concerns in these
patients, limiting this treatment to anecdotal reports of highly selected
cases. However, major improvements in the overall and progression-free survival
due to newer treatment options, lead us to challenge the perception that
patients with PCD are never suitable candidates for renal transplantation. As
sustained periods of disease stabilization are currently possible, we suggest
that renal transplantation may now be considered early in the course of the
disease, especially in dialysis-dependent younger patients with a good
performance status. In such patients, waiting for 3–5 years of sustained
disease control to elapse appropriate before renal transplantation is not
appropriate if the benefits of renal transplantation are to be maximized.”
Other key quotes from the article are:
Multiple Myeloma and Cast
Nephropathy: “There
are a number of isolated reports describing renal transplantation in patients
with cast nephropathy coming from specialized centres. European Best Practice
Guidelines [Nephrol Dial Transplant 2000;15(suppl 7)], advise a waiting period
of at least 2 years between successful induction treatment and renal
transplantation. However, with the availability of newer and more potent drugs,
ASCT and novel treatment regimens, it is reasonable to reappraise these
recommendations.”
Monoclonal
Immunoglobulin Deposition Disease (MIDD): “Renal transplantation is generally not considered in
patients with MIDD due to almost universal recurrence of the disease and poor
survival of the allograft, though a small number of transplants have been
performed with the possibility of prolonging patient survival. Early recurrence
in the allograft is more common in MIDD patients in whom necrotizing or crescentic
glomerulonephritis or membranoproliferative glomerulonephritis is a primary
presentation of PCD in native kidneys.”
AL
Amyloidosis: "Early experiences with renal transplantation in amyloidosis
showed poor outcome with high post-transplant mortality and graft loss …In two of the biggest series so far. These studies have
shown a renal allograft survival ranging from 18 to 72 months without clinical
or histological evidence of recurrence. These data suggest that renal
transplantation could be considered in patients with preserved performance
status, who have little or no clinically significant amyloid deposition in
other organs and have at least achieved a partial remission with chemotherapy
with or without ASCT…..there is no clear guidance regarding renal
transplantation in AL amyloidosis in current European Best Practice Guidelines [Nephrol
Dial Transplant 2000;15(suppl 7)], it has not been considered as an absolute
contraindication."
