Amyloidosis Diagnosed in Solid Organ Transplant Recipients

Abstract

AA-AA amyloidosis (previously known as secondary amyloidosis) AL-AL amyloidosis (previously known as primary amyloidosis) CR-complete response CRP-C-reactive protein MGUS-monoclonal gammopathy of undetermined significance NR-no response PCN-plasma cell neoplasia PD-progressive disease PR-partial response PTLD-post-transplant lymphoproliferative disorder SAA-serum amyloid A protein VGPR-very good partial response wtATTR-wild type transthyretin amyloidosis ConclusionsThis series is the first description of amyloidosis post solid organ transplant; 30 cases among 5,112 amyloid patients over 24 years suggests that amyloidosis may occur post solid organ transplantation with an overall poor survival.

Daratumumab-based Regimen in Treating Clonal Plasma Cell Neoplasms in Solid Organ Transplant Recipients

“…10 , 11 One registry study suggests that the frequency of AL amyloidosis may be elevated in the post-SOT setting, although the evidence is correlative and retrospective without definitive clinical-translational support. 8 We analyzed the effectiveness of a Dara-based regimen for the treatment of clonal plasma cell neoplasm in SOT recipients. Our results indicate variable success among the 2 evaluated types of plasma cell dyscrasias: (1) systemic AL amyloidosis, and (2) PTLD-EP.…”

“…Given his comorbidities, the patient was felt not to be a candidate for autologous peripheral blood stem cell transplantation, and thus began treatment with CyBorD (cyclophosphamide, bortezomib, and dexamethasone) as previously described. 8 He completed 11 cycles of therapy, leading to very good partial response (VGPR) based on previously published consensus criteria. 9 Cycle 2 of CyBorD therapy was complicated by elevated liver enzymes and hyperbilirubinemia e a liver biopsy demonstrated mild acute cellular rejection and focal deposition of amyloid by Congo red (Figure 3A-C); a previous liver biopsy, performed 2 years earlier, showed no amyloidosis.…”

“…Given his comorbidities, the patient was felt not to be a candidate for autologous peripheral blood stem cell transplantation, and thus began treatment with CyBorD (cyclophosphamide, bortezomib, and dexamethasone) as previously described. 8 He completed 11 cycles of therapy, leading to very good partial response (VGPR) based on previously published consensus criteria. 9 …”

NEPHRO–ZEBRA-acute troponin increase in a kidney transplant recipient–the unknown knowns?

“…Nevertheless, why would this patient have de novo cardiac SAA? Only 11 of the 5112 amyloidosis patients from a large database developed de novo AA amyloidosis post transplantation , nine of whom were kidney transplant recipients [ 3 ]. Six of the eleven patients had renal, and none had cardiac amyloidosis.…”

Recurrent Glomerular Disease after Kidney Transplantation

“…Bortezomib has been studied for the treatment of antibody-mediated rejection and does not require dose adjustment for kidney function. There are limited descriptions for the use of bortezomib for multiple myeloma and AL amyloidosis after kidney transplant (63,64). The anti-CD38 antibody daratumumab has shown efficacy as an add-on therapy for AL amyloidosis (65).…”