Single-center outcomes of renal transplantation in patients with AL amyloidosis
Wiest, Amanda Theresa
MetadataShow full item record
AL amyloidosis is a relatively rare but deadly systemic disease that is characterized by the deposition of clonal immunoglobulins into many organs, resulting in organ dysfunction. Amyloid deposition in the kidneys is the highest cause of morbidity in this subset of patients while amyloid deposition in the heart remains the largest cause of mortality. Most patients diagnosed with AL amyloidosis will end up with renal dysfunction that will progress to ESRD, requiring treatment with dialysis if not treated. Advancements in treatment for AL amyloidosis in recent years, specifically the use of high dose melphalan followed by stem cell transplantation, has drastically improved the survival of these patients. As a result, more patients are living with the consequences of irreversible organ damage. Many studies have demonstrated that renal transplantation is associated with improved overall survival and quality of life when compared to dialysis for treatment of ESRD for any indication. However, renal transplantation for ESRD in patients with AL amyloidosis has not been considered to be feasible due to the risks of disease relapse and graft failure. Therefore, renal transplantation for patients with AL amyloidosis is not routinely considered in most medical centers. A few multidisciplinary centers have demonstrated the feasibility of renal transplantation with improved overall survival and low rates of graft failure. The proposed retrospective analysis of patients undergoing renal transplantation for AL amyloidosis vs. other indications is suspected to demonstrate a 25 percent difference in median graft survival between the two groups, thus showing that patients with end stage renal disease (ESRD) secondary to AL amyloidosis should be given the same consideration for renal transplantation as patients with ESRD secondary to other causes.