Effect of Amyloidosis on Long-Term Survival in Kidney Transplantation (original) (raw)
Related papers
Outcome of Kidney Transplantation for Renal Amyloidosis:A Single-Center Experience
Transplantation Proceedings, 2006
The aim of this retrospective study was to investigate the results of kidney transplantation in patients with renal amyloidosis. We analyzed the results of renal transplantation in 13 amyloidotic transplant recipients compared with those in a control group of 13 nonamyloidotic patients. While the etiology of amyloidosis was rheumatoid arthritis in one patient, in all of the others it was secondary to familial Mediterranean fever. Acute rejection episodes developed once in six and twice in one patient. The renal function in these patients was improved by antirejection treatment. Chronic rejection did not develop in any patient. However six patients (46%) died due to various complications despite functional grafts. The others are still being followed with well-functioning grafts. Among the control group, acute and chronic rejection were diagnosed in three and two patients, respectively: one patient returned to hemodialysis after 26 months of transplantation, while the others are still alive with functional grafts. There was no death in the control group. The 5-and 10-year actuarial patient survival rates of the amyloidosis and control groups were 52.2%, 26.6%, and 100%, 100%, respectively (P ϭ .002). However, the graft survivals of the amyloidosis versus control groups were 100%, 100%, versus 87.5%, 87.5, respectively (P ϭ .47). In conclusion, we observed a high rate of early mortality among recipients with amyloidosis associated with infectious complications. Moreover, patient survivals were lower among amyloidotic renal recipients.
Long-term outcome of live donor kidney transplantation for renal amyloidosis
American Journal of Kidney Diseases, 2003
Background: The short-term outcome of kidney transplantation in patients with amyloidosis has been reported. The aim of this study is to investigate long-term results in patients with renal amyloidosis. Methods: We studied results of renal transplantation in 23 amyloidotic transplant recipients compared with those in a control group of 47 nonamyloidotic patients. Amyloidosis was secondary to familial Mediterranean fever (FMF) in 16 patients, whereas it was primary (idiopathic) in 7 transplant recipients. The 2 groups were homogeneous regarding age, sex, HLA matching, immunosuppression, and duration of transplantation. Results: Five-and 10-year actuarial graft survival rates were similar in both groups (79.35% versus 84.04% and 65.92% versus 56.61%, respectively ). Five-and 10-year actuarial patient survival rates also were similar (80% versus 94% and 68% versus 87%, respectively). Moreover, 72.4% of controls experienced at least 1 rejection episode, whereas only 43.5% of amyloidotic transplant recipients experienced 1 or more such events (P ؍ 0.02). Nonetheless, mean serum creatinine concentrations did not differ between the 2 groups during the observation period. Maintenance colchicine therapy prevented the recurrence of both FMF symptoms and amyloidosis. Recurrence was documented in only 1 amyloidotic transplant recipient (4.3%) 10 years posttransplantation. Significant gastrointestinal (GI) problems were more frequent in amyloidotic patients (65% versus 38%; P ؍ 0.03). Amyloidotic patients with GI problems, except for 2 patients, were administered cyclosporine. Eleven of these patients had FMF, which appeared to reflect the effects of both cyclosporine and colchicine. Infections were similar in the groups; whereas amyloidotic patients had significantly lower blood pressures. Conclusion: In our experience, long-term (5 to 10 years) outcome of live related donor kidney transplantation in patients with amyloidosis is similar to that in the general transplant population. Am J Kidney Dis 42:370-375.
Fifteen years' experience with renal transplantation in systemic amyloidosis
Transplant International, 1992
A . H a r t m a n n 1 , H . H o l d a a s I , P. F a u c h a l d 1 , K. P. N o r d a l I , K. J. B e r g 1 , T. T a l s e t h 1 , T. L e i v e s t a d 3 , I. B . B r e k k e 2 , a n d A . F l a t m a r k 2 A b s t r a c t . At our center 62 renal transplantations (31 living donor and 31 cadaveric donor grafts) have been performed in 58 patients with amyloid renal disease since 1974. The amyloidosis was secondary to rheumatic disease in 74 % of the patients. Predialytic transplantation was performed in 28 % of the patients. Mean follow-up time was 5.1 years (0.3-14.5 years).
2011
Although end-stage renal disease related to AA amyloidosis nephropathy is well characterized, there are limited data concerning patient and graft outcome after renal transplantation. We performed a multicentric retrospective survey to assess the graft and patient survival in 59 renal recipients with AA amyloidosis. The recurrence rate of AA amyloidosis nephropathy was estimated at 14%. The overall, 5-and 10-year patient survival was significantly lower for the AA amyloidosis patients than for a control group of 177 renal transplant recipients (p = 0.0001, 0.028 and 0.013, respectively). In contrast, we did not observe any statistical differences in the 5-and 10-year graft survival censored for death between two groups. AA amyloidosistransplanted patients exhibited a high proportion of infectious complications after transplantation (73.2%). Causes of death included both acute cardiovascular events and fatal septic complications. Multivariate analysis demonstrated that the recurrence of AA amyloidosis on the graft (adjusted OR = 14.4, p = 0.01) and older recipient age (adjusted OR for a 1-year increase = 1.06, p = 0.03) were significantly associated with risk of death. Finally, patients with AA amyloidosis nephropathy are eligible for renal transplantation but require careful management of both cardiovascular and infectious complications to reduce the high risk of mortality.
Study of live donor kidney transplantation outcome in recipients with renal amyloidosis
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 1994
We studied the results of renal transplantation in 16 patients with renal amyloidosis and in 46 controls with primary glomerulonephritis. Amyloidosis was primary in five and secondary to familial Mediterranean fever (FMF) in 11. All patients received live related donor kidneys and the majority had one-haplotype HLA match. One- and 5-year graft and patient survival rates were comparable in both groups. Moreover, the frequency of acute rejection episodes and the mean serum creatinine values were not significantly different between members of the two groups. Significant gastrointestinal symptoms in the form of nausea, vomiting, abdominal pains, and diarrhoea occurred in seven of the patients with amyloidosis (43.7%) and in only one of the controls (2%) (P = 0.001). All seven recipients with amyloidosis who developed the gastrointestinal manifestations were receiving cyclosporin and six had FMF. Maintenance colchicine treatment prevented recurrence of FMF symptoms. In one patient discon...
Transplantation Proceedings, 2006
The aim of this study was to investigate the results of renal transplantation in amyloidosis patients compared with those on hemodialysis. We compared a group of 25 patients with systemic amyloidosis and end-stage renal disease (ESRD) treated with renal transplantation with a control group of 30 patients with systemic amyloidosis and ESRD treated with hemodialysis. Overall 1-, 2-, and 5-year survival rates were 86.9%, 82.6%, and 78.2%, respectively, for patients, who had renal transplantations versus 60.7%, 50%, and 46.4%, respectively, for patients on hemodialysis treatments (P Ͻ .001). Among the control group 15 patients died at 9.4 Ϯ 7.5 months after starting hemodialysis. Among transplantation group five patients died during follow-up (mean 12.3 Ϯ 13.6 months); the major cause of death was infection. Only 18 patients experienced recurrences after renal transplantation; their 5-year survival rate was 84.2% versus 50% for patients who had no recurrence (P Ͻ .001). Patients with amyloid recurrence also had better long-term survival rates than patients in hemodialysis group (P Ͻ .001). In conclusion amyloidotic patients maintained on chronic dialysis have a high mortality rate. Better survival was noted for patients who had renal transplantations despite recurrences. These results encourage transplantation in amyloid renal end-stage disease.
Outcome of Renal Transplantation in Amyloidosis
Transplantation Journal, 2004
Aims: After the first kidney transplantation performed by Murray in 1954, it has been considered as the best treatment choice for endstage renal disease around the world. However, in spite of the expertness of the procedure, improvement of new immunosuppressant drugs, and improvement of understanding about human immune system, rejection still is the dilemma of kidney transplantation. This study is designed to find the predictor for long-term renal allograft survival in episodes of rejection. Methods: We analyzed 239 recipient patients who experienced rejection among 1509 kidney transplantation cases done in Asan Medical Center between June 1990 and January 2004. Cases corresponded to simultaneous pancreas-kidney transplantation and immediate allograft removal hyperacute rejected transplant were excluded from the study. We paid attention to time of onset of rejection, HLA-DR matching, types of immunosuppressant regimen, amount of perioperative transfusion, serum creatinine level before and after the first attack of rejection, and reversibility of functional allograft survival rates. All the data were analyzed using SPSS software (Release 10.0, SPSS Inc., IL). Kaplan Meier method and Cox proportional hazards model were used for comparing the data. Results: 1) In a viewpoint of onset time of rejection (3, 6 month, 1 year after kidney transplantation), there was no statistical significance shown in renal allograft survival. 2) There were no statistically significant numbers of HLA-DR matching in renal allograft survival. 3) There was no statistical significance shown in renal allograft survival in the viewpoint of immunosuppressant regimen. 4) There was no statistical significance shown in renal allograft survival in the viewpoint of amount of perioperative transfusion. 5) There was no statistical significance shown in renal allograft survival in the viewpoint of immunosuppressant regimen. 6) There was statistical significance shown in renal allograft survival between groups of 1 day creatinine level after operation above and below 4.0(pϭ0.01). 7) DCr was defined as difference between highest and lowest creatinine level in the course of first rejection, and there was statistical significance shown in renal allograft survival between groups of DCr above and below 1.0(pϭ0.03). 8) DDCr was defined as difference between lowest creatinine level in the course of first rejection and baseline creatinine level primarily after kidney transplantation, and there was statistical significance shown in renal allograft survival between groups of DDCr, that is,-0.3ϳ0.3, 0.4ϳ0.6, 0.7ϳ1.0, 1.1ϳ1.5, more than 1.6, less than-0.4(pϭ0.0019). 9) rejCr was defined as highest creatinine level in the course of first rejection, and there was statistical significance shown in renal allograft survival between groups of rejCr above and below 3.0(pϭ0.0003). 10) There was statistic significance shown in renal allograft survival between groups of one month creatinine level after completion of rejection treatment above and below 1.7(pϭ0.046). 11) In multivariate analysis, DCr, rejCr, DDCr, one month creatinine level after completion of rejection treatment were found as statistically significant factors(pϭ0.027, 0.002, Ͻ0.0001, 0.023). Conclusions: Rejection after kidney transplantation has been known as major factor having a negative effect upon the renal allograft survival. As of occurrence of rejection, prediction of long-term renal allograft survival will be a great help to our decision making about treatment. At this point we suggest that DCr, DDCr of initial rejection episode is a great predictor on long-term renal allograft survival.
American Journal of Transplantation, 2013
Renal transplantation remains contentious in patients with systemic amyloidosis due to the risk of graft loss from recurrent amyloid and progressive disease. Outcomes were sought among all patients attending the UK National Amyloidosis Centre who received a renal transplant (RTx) between January 1978 and May 2011. A total of 111 RTx were performed in 104 patients. Eighty-nine percent of patients with end-stage renal disease (ESRD) due to hereditary lysozyme and apolipoprotein A-I amyloidosis received a RTx. Outcomes following RTx were generally excellent in these diseases, reflecting their slow natural history; median graft survival was 13.1 years. Only 20% of patients with ESRD due to AA, AL and fibrinogen amyloidosis received a RTx. Median graft survival was 10.3, 5.8 and 7.3 years in these diseases respectively, and outcomes were influenced by fibril precursor protein supply. Patient survival in AL amyloidosis was 8.9 years among those who had achieved at least a partial clonal response compared to 5.2 years among those who had no response (p = 0.02). Post-RTx chemotherapy was administered successfully to four AL patients. RTx outcome is influenced by amyloid type. Suppression of the fibril precursor protein is desirable in the amyloidoses that have a rapid natural history.