Amyloidosis Diagnosed in Solid Organ Transplant Recipients.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
entrez:
1
2
2020
pubmed:
1
2
2020
medline:
30
9
2020
Statut:
ppublish
Résumé
Development of amyloidosis post solid-organ transplantation has not been reported, although plasma cell neoplasms are a rare form of posttransplant lymphoproliferative disorder, which could be complicated by light chain amyloidosis (AL) amyloidosis. We searched our database of 5112 patients seen between 1994 and 2018 with a diagnosis of amyloidosis post solid-organ transplant. Patients were excluded if the amyloid diagnosis preceded the transplant date. The indication and type of organ transplant were recorded in addition to the amyloidosis type, organs involved, treatment given, and survival. Thirty patients were identified. The median age at diagnosis with amyloidosis was 52 years (range 33-77). The median time from transplantation to diagnosis was 10.5 years (0.58-36). The grafts were kidney (N = 25, 83.3%), liver (N = 2, 6.7%), heart (N = 2, 6.7%), and combined heart, lung, and kidney (N = 1, 3.3%). The type of amyloidosis was systemic AL (N = 14, 47%), serum amyloid A amyloidosis (AA) (N = 11, 37%), localized AL (N = 3, 10%), wild-type transthyretin amyloidosis (ATTR) (N = 1, 3.3%), and amyloid of uncertain type (N = 1, 3.3%). Renal graft dysfunction was seen in 11 of 25 (44%) cases. Median graft survival was 185 months (96-269), and median survival from diagnosis with amyloidosis was 45 months (2-89); median survival by amyloidosis type was localized AL: 64 months (20-67), systemic AL: 23.5 months (0-95), ATTR amyloidosis: 17 months, and AA, 15 months (0-77). This series is the first description of amyloidosis post solid-organ transplant; 30 cases among 5112 amyloid patients >24 years suggests that amyloidosis may occur post solid-organ transplantation with an overall poor survival.
Sections du résumé
BACKGROUND
Development of amyloidosis post solid-organ transplantation has not been reported, although plasma cell neoplasms are a rare form of posttransplant lymphoproliferative disorder, which could be complicated by light chain amyloidosis (AL) amyloidosis.
METHODS
We searched our database of 5112 patients seen between 1994 and 2018 with a diagnosis of amyloidosis post solid-organ transplant. Patients were excluded if the amyloid diagnosis preceded the transplant date. The indication and type of organ transplant were recorded in addition to the amyloidosis type, organs involved, treatment given, and survival.
RESULTS
Thirty patients were identified. The median age at diagnosis with amyloidosis was 52 years (range 33-77). The median time from transplantation to diagnosis was 10.5 years (0.58-36). The grafts were kidney (N = 25, 83.3%), liver (N = 2, 6.7%), heart (N = 2, 6.7%), and combined heart, lung, and kidney (N = 1, 3.3%). The type of amyloidosis was systemic AL (N = 14, 47%), serum amyloid A amyloidosis (AA) (N = 11, 37%), localized AL (N = 3, 10%), wild-type transthyretin amyloidosis (ATTR) (N = 1, 3.3%), and amyloid of uncertain type (N = 1, 3.3%). Renal graft dysfunction was seen in 11 of 25 (44%) cases. Median graft survival was 185 months (96-269), and median survival from diagnosis with amyloidosis was 45 months (2-89); median survival by amyloidosis type was localized AL: 64 months (20-67), systemic AL: 23.5 months (0-95), ATTR amyloidosis: 17 months, and AA, 15 months (0-77).
CONCLUSIONS
This series is the first description of amyloidosis post solid-organ transplant; 30 cases among 5112 amyloid patients >24 years suggests that amyloidosis may occur post solid-organ transplantation with an overall poor survival.
Identifiants
pubmed: 32004234
doi: 10.1097/TP.0000000000002813
pii: 00007890-202002000-00032
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
415-420Subventions
Organisme : British Heart Foundation
ID : FS/18/21/33447
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Références
Burns DM, Crawford DH. Epstein-barr virus-specific cytotoxic T-lymphocytes for adoptive immunotherapy of post-transplant lymphoproliferative disease.Blood Rev200418193–209
Ison MG, Stosor V. Transplantation of high-risk donor organs: a survey of US solid organ transplant center practices as reported by transplant infectious diseases physicians.Clin Transplant200923866–873
Parker A, Bowles K, Bradley JA, et al.; Haemato-oncology Task Force of the British Committee for Standards in Haematology and British Transplantation SocietyDiagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients - BCSH and BTS guidelines.Br J Haematol2010149675–692
Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the world health organization classification of lymphoid neoplasms.Blood20161272375–2390
Morrison VA, Dunn DL, Manivel JC, et al. Clinical characteristics of post-transplant lymphoproliferative disorders.Am J Med19949714–24
Engels EA, Pfeiffer RM, Fraumeni JF Jr, et al. Spectrum of cancer risk among US solid organ transplant recipients.Jama20113061891–1901
Engels EA, Clarke CA, Pfeiffer RM, et al. Plasma cell neoplasms in US solid organ transplant recipients.Am J Transplant2013131523–1532
Pinney JH, Smith CJ, Taube JB, et al. Systemic amyloidosis in England: an epidemiological study.Br J Haematol2013161525–532
Lavatelli F, Perlman DH, Spencer B, et al. Amyloidogenic and associated proteins in systemic amyloidosis proteome of adipose tissue.Mol Cell Proteomics200871570–1583
Saeger W, Röcken C. [Amyloid: microscopic demonstration, classification and clinical correlation].Pathologe199819345–354
Gillmore JD, Wechalekar A, Bird J, et al.; BCSH CommitteeGuidelines on the diagnosis and investigation of AL amyloidosis.Br J Haematol2015168207–218
Gertz MA, Comenzo R, Falk RH, et al. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th international symposium on amyloid and amyloidosis, Tours, France, 18-22 April 2004.Am J Hematol200579319–328
Pinney JH, Whelan CJ, Petrie A, et al. Senile systemic amyloidosis: clinical features at presentation and outcome.J Am Heart Assoc20132e000098
Gillmore JD, Damy T, Fontana M, et al. A new staging system for cardiac transthyretin amyloidosis.Eur Heart J2018392799–2806
Mahmood S, Bridoux F, Venner CP, et al. Natural history and outcomes in localised immunoglobulin light-chain amyloidosis: a long-term observational study.Lancet Haematol20152e241–e250
Papa R, Lachmann HJ. Secondary, AA, amyloidosis.Rheum Dis Clin North Am201844585–603
Milani P, Merlini G, Palladini G. Light chain amyloidosis.Mediterr J Hematol Infect Dis201810e2018022
Radl J, Valentijn RM, Haaijman JJ, et al. Monoclonal gammapathies in patients undergoing immunosuppressive treatment after renal transplantation.Clin Immunol Immunopathol19853798–102
Cuéllar-García C, Sevillano Ruiz-Mateos C, Mazuecos Blanca MA, et al. Follow-up monoclonal gammopathy of undetermined significance in kidney transplant.Transplant Proc20154778–80
Kumar S, Dispenzieri A, Lacy MQ, et al. Revised prognostic staging system for light chain amyloidosis incorporating cardiac biomarkers and serum free light chain measurements.J Clin Oncol201230989–995