Suitability for Kidney Transplantation in AL Amyloidosis: A Survey Study of Transplant and Amyloidosis Physicians : Kidney360

Journal Logo

Original Investigation: Transplantation

Suitability for Kidney Transplantation in AL Amyloidosis: A Survey Study of Transplant and Amyloidosis Physicians

Lam, Robert1; Lim, Mary Ann2; Dember, Laura M.2,3,4

Author Information
Kidney360 2(12):p 1987-1997, December 2021. | DOI: 10.34067/KID.0004232021
  • Open
  • Infographic
  • SDC

Abstract

Introduction

Amyloidosis is a rare disorder in which soluble proteins aggregate and deposit in tissues as insoluble fibrils, causing progressive organ dysfunction (1). Amyloid light chain (AL) amyloidosis is the most common type of amyloidosis, with an estimated prevalence of 50 per million adults in the United States (2,3). AL amyloidosis results from the production of amyloidogenic immunoglobulin light chains by clonal plasma cells in the bone marrow that deposit as amyloid in the kidney, heart, liver, and/or autonomic nervous system (4). Progressive accumulation of amyloid in the kidney often leads to ESKD (1).

Advances in treatments targeting plasma cells, such as high-dose melphalan with autologous stem cell transplantation, lenalidomide, bortezomib, and, more recently, daratumumab, have led to higher rates of hematologic responses, clinical responses, and survival (567–8). With improvements in the attainment and durability of hematologic responses, kidney transplantation may be considered as an alternative to dialysis for kidney replacement therapy among patients who develop AL amyloidosis–associated kidney failure. A recent retrospective analysis by a single center found that survival for patients with AL amyloidosis who underwent kidney transplantation was 12.4 years, compared with 24–39 months for those treated with dialysis, and that allograft survival was >5 years for 81% of the patients (9).

Currently, there are not established criteria for determining suitability for kidney transplantation for patients with AL amyloidosis–associated kidney failure. Because the disease is rare, many transplant programs have limited experience with pre- and post–kidney transplant care for patients with AL amyloidosis. Conversely, amyloidosis specialists have limited experience caring for patients with AL amyloidosis who have undergone kidney transplantation. As an early step toward a longer term goal of developing criteria for kidney transplantation in AL amyloidosis, we performed a survey study of both amyloidosis specialists and kidney transplant specialists to characterize approaches and considerations when determining kidney transplant suitability for this patient population.

Materials and Methods

We developed surveys consisting of 23 questions for transplant nephrologists and amyloidosis experts using the Qualtrics platform (see Supplemental Appendices 1 and 2 for surveys). Multiple-choice, Likert-scale, and ranking-style questions were used. Although most questions were common to both surveys, there were also specialty-specific questions. Before its distribution, each survey was reviewed by content experts who were not eligible for subsequent participation in the study.

Transplant nephrology programs were identified from the website of the US Scientific Registry of Transplant Recipients (10). Surveys were sent to the medical directors of kidney transplant programs that had annual kidney transplant volumes within the top 100 of the 256 programs. If the website did not designate a medical director, the survey was sent to a different transplant nephrologist from the program. Email addresses for the transplant medical director or a transplant nephrologist were obtained from the program’s website or the American Society of Nephrology membership directory. Invitations to participate were sent by electronic mail during the period from November 1, 2018 through March 1, 2019. A maximum of three contacts were made to each potential participant.

We identified 31 dedicated amyloidosis treatment programs in the United States and initially contacted one member from each program. We initially contacted hematologist-oncologists, and, if there was no response, we contacted a physician member from a different discipline. Email addresses were obtained from program websites. Invitations to participate were sent by electronic mail during the period from March 2, 2018 through April 3, 2019. A maximum of three contacts were made to each potential participant.

Recipients of the surveys were informed that participation was voluntary and that responses would not be identified by name or institution. The study was conducted in accordance with the Declaration of Helsinki and deemed exempt for review by the Institutional Review Board of the University of Pennsylvania (protocol number 828184), as authorized by title 45 of the Code of Federal Regulations, section 46.101, category 2.

Results

Characteristics of Survey Respondents and Programs

The amyloidosis program survey was sent to 31 physicians, each representing a single amyloidosis center. Completed surveys were received from 20 programs (65%). The transplantation program survey was sent to 70 physicians, each representing a single kidney transplantation center. Completed surveys were received from 20 programs (29%).

The characteristics of the survey respondents are shown in Table 1. For the amyloidosis programs, the respondents described themselves as hematologist-oncologists (90%) or hematologists (10%), and for the kidney transplant programs, all of the respondents were nephrologists. Program age ranged from <5 to >20 years for the amyloidosis programs and was ≥20 years for most of the transplant programs. For the transplant programs, 75% had four or more transplant nephrologists, 75% had four or more transplant surgeons, and the median annual number of kidney transplants performed per year was 234 (interquartile range, 164–271), which falls within the top 75th percentile for United States centers (10). All of the amyloidosis program respondents and most of the kidney transplant program respondents reported availability of autologous stem cell transplantation at their institutions. Among the kidney transplant program respondents, 55% reported having physicians at their institution with particular expertise in amyloidosis. A greater proportion of amyloidosis program respondents (85%) were comfortable or very comfortable answering the survey questions compared with kidney transplant program respondents (60%) (Supplemental Figure 1).

Table 1. - Characteristics of programs for survey respondents
Characteristics Amyloidosis Programs Kidney Transplant Programs
Type of center, n (%)
 Academic medical center 19 (95) 17 (85)
 Community hospital, not affiliated with an academic medical center 0 (0) 2 (10)
 Veterans Administration hospital 1 (5) 1 (5)
Age of program, yr, n (%)
 <5 0 (0) 0 (0)
 5–9 0 (0) 0 (0)
 10–19 4 (20) 4 (20)
 >20 16 (80) 16 (80)
Number of affiliated amyloidosis physicians, n (%)
 <5 9 (45) NA
 5–9 7 (35) NA
 10–19 2 (10) NA
 >20 2 (10) NA
Number of affiliated transplant nephrologists, n (%)
 1 NA 0 (0)
 2 NA 3 (15)
 3 NA 2 (10)
 4 NA 4 (20)
 5 NA 7 (35)
 >5 NA 4 (20)
Number of affiliated transplant surgeons, n (%)
 1 NA 0 (0)
 2 NA 3 (15)
 3 NA 2 (10)
 4 NA 1 (5)
 5 NA 5 (25)
 >5 NA 9 (45)
Number of kidney transplants per year, median (IQR) a NA 234 (164–271)
Autologous stem cell transplantation available, n (%)
 Yes 20 (100) 17 (85)
 No 0 (0) 3 (15)
Medical specialty for survey respondent, n (%)
Amyloidosis program hematologist-oncologist or hematologist 20 (100) NA
 Other amyloidosis program specialist 0 (0) NA
 Transplant program nephrologist NA 20 (100)
 Other transplant program specialist NA 0 (0)
NA, not applicable; IQR, interquartile range.
aFrom the Scientific Registry of Transplant Recipients (https://www.srtr.org/transplant-centers/?organ=kidney).

At the amyloidosis programs, the number of patients during the prior 3 years who received care after a kidney transplant ranged from zero to more than ten (Figure 1). Most of the kidney transplant program respondents reported that, during the prior 3 years, their program had performed kidney transplants for one to five patients with amyloidosis (Figure 1). For both the kidney transplant and amyloidosis programs, most respondents reported that their programs had evaluated one to ten patients with amyloidosis for kidney transplantation during the preceding 3 years (Supplemental Figure 2).

F1
Figure 1.:
Experience during the prior 3 years with kidney transplantation in amyloid light chain amyloidosis. (A) Amyloidosis centers: number of patients with amyloidosis receiving care after kidney transplantation. (B) Transplant centers: number of amyloidosis patients receiving a kidney transplant.

Perceptions about Assessing Suitability for Kidney Transplantation

There was general agreement between the amyloidosis and transplant program respondents that transplant nephrologists have limited experience with both evaluating suitability for kidney transplantation and providing post-transplant care for patients with AL amyloidosis (Figure 2). The level of confidence in assessing suitability for kidney transplantation for patients with AL amyloidosis was greater among the amyloidosis program respondents than among the transplant program respondents, with a high or very high level of confidence reported by 80% of amyloidosis program respondents, compared with 45% of transplant program respondents (Supplemental Figure 3). Most amyloidosis and kidney transplant program respondents agreed or strongly agreed that there is greater uncertainty about the outcome of the kidney allografts for patients with AL amyloidosis than for most other kidney transplant recipients (Figure 2). Furthermore, both amyloid and kidney transplant program respondents expressed the view that there is not a strong consensus among kidney transplant physicians about which patients with AL amyloidosis are suitable for kidney transplantation (Figure 2).

F2
Figure 2.:
Perspectives about kidney transplantation for amyloid light chain (AL) amyloidosis–associated kidney failure. Survey respondents indicated their level of agreement with the statements shown along the x axis.

Key Factors for Determining Suitability for Kidney Transplantation

Amyloidosis programs rated from most important to least important the following factors when considering suitability of patients with AL amyloidosis for kidney transplant: (1) anticipated patient survival, (2) potential for amyloid deposition in the allograft, (3) available therapeutic agents for treating AL amyloidosis after kidney transplantation, (4) anticipated allograft survival, and (5) effects of transplant immunosuppression on clonal plasma cells (Figure 3A). The rankings by the kidney transplant programs were similar, except that allograft survival was ranked more highly by transplant program respondents than by amyloidosis program respondents (Figure 3B).

F3
Figure 3.:
Relative importance of factors for determining suitability for kidney transplantation. (A) Amyloidosis program respondents and (B) transplantation program respondents. Respondents ranked each factor using a scale of 1 to 5, with 1 indicating least important and 5 indicating most important. Each ranking could be applied to only one factor.

Most amyloidosis program respondents (65%) and kidney transplant program respondents (75%) reported that the minimum expected life expectancy should be 5 years to be suitable for kidney transplantation (Supplemental Figure 4). There was greater comfort proceeding with kidney transplantation as early as 6 months after autologous stem cell transplantation among amyloidosis program respondents (50%) than among transplant program respondents (15%), most of whom felt that kidney transplantation should not be performed until 1 year (40%) or 2 years (40%) after autologous stem cell transplantation (Figure 4). For both the amyloidosis and transplant programs, most respondents (75% and 60%, respectively), recommended not proceeding with kidney transplantation if the 6-month evaluation after autologous stem cell transplantation indicates a partial, rather than complete, hematologic response (Supplemental Figure 5).

F4
Figure 4.:
Earliest acceptable time for kidney transplantation in amyloid light chain (AL) amyloidosis if there is a complete hematologic response with autologous stem cell transplantation.

The type of treatment approach used to achieve pre–kidney transplant complete hematologic response was important in determining kidney transplant suitability to some, but not all, of the survey respondents and, overall, was ranked as less important by the amyloidosis program than the transplant program respondents (Figure 5). Among those responding that treatment type was an important determinant of transplant suitability, both the amyloidosis program and transplant program respondents responded more favorably if the hematologic response had been achieved with a bortezomib-based treatment or with high-dose melphalan/stem cell transplantation than if the hematologic response had been achieved with a lenalidomide-based regimen (Figure 6).

F5
Figure 5.:
Relative importance of treatment approach used to achieve the patient’s pre–kidney transplant hematologic status when considering kidney transplant eligibility.
F6
Figure 6.:
Views on proceeding with kidney transplantation on the basis of the treatment approach that led to a complete hematologic response.

For patients with a complete hematologic response, extrarenal involvement was a relevant determinant of suitability for kidney transplantation for both amyloidosis and kidney transplant program respondents. For patients with a mild degree of amyloid liver disease, 68% of amyloidosis program respondents and 55% of kidney transplant program respondents found kidney transplantation to be acceptable (Figure 7A); however, with moderate liver involvement, kidney transplantation was considered appropriate by only 27% and 18% of amyloidosis program and kidney transplant program respondents, respectively. Only 5% of amyloidosis program respondents, compared with 27% of kidney transplant program respondents, felt that any evidence of liver involvement precluded kidney transplantation (Figure 7A). For cardiac involvement, approximately half of respondents in both groups were comfortable proceeding with kidney transplant if the involvement was mild, but few respondents in either group (5% for amyloidosis programs and 0% for transplant programs) were comfortable with kidney transplantation in the presence of severe involvement. For transplant program respondents, 38% felt that any degree of cardiac involvement, even subclinical disease, precluded kidney transplantation. In contrast, only 9% of amyloidosis program respondents indicated that any degree of cardiac involvement precluded kidney transplantation. (Figure 7B).

F7
Figure 7.:
Acceptability of kidney transplantation in the presence of extrarenal amyloid disease. (A) Liver involvement. Mild liver involvement was defined as histologic evidence without hepatomegaly or persistent elevation in alkaline phosphatase concentration. Moderate liver involvement was defined as hepatomegaly or persistent elevation in alkaline phosphatase concentration, without ascites, bilirubin elevation, or impaired hepatic synthetic function. Severe but well-controlled liver involvement was defined as ascites, bilirubin elevation, or impaired synthetic function, but minimal functional limitations with medical management. Severe, but not well-controlled, liver involvement was defined as persistent ascites, bilirubin elevation, or impaired synthesis not responsive to medical management. (B) Cardiac involvement. Mild cardiac involvement was defined as histologic evidence of amyloid without electrocardiographic evidence of amyloid heart disease. Moderate cardiac involvement was defined as electrocardiographic and echocardiographic evidence of amyloid heart disease, but with no clinical manifestations or functional limitation. Severe, but well-controlled, cardiac involvement was defined as clinically evident disease, but minimal functional limitations with medical management such as diuretics. Severe, but not well-controlled, cardiac involvement was defined as clinically evident disease with significant functional limitations despite medical management such as diuretics.

As shown in Figure 8, views about the use of anti–plasma cell therapy, if required, after kidney transplantation differed on the basis of the treatment regimen. For both amyloidosis and transplant program respondents, the greatest comfort was with bortezomib-based treatment and the lowest level of comfort was with lenalidomide-based treatment. For all of the treatment approaches, amyloidosis program respondents had a greater level of comfort than did transplant program respondents. Nearly all amyloidosis program respondents (90%) reported no concerns about bortezomib use after kidney transplantation. In contrast, kidney transplant program respondents were approximately equally divided between having no concerns (50%) and having some degree of concern (45%) about the use of bortezomib (Figure 8A). For treatment with high-dose melphalan with autologous stem cell transplantation, 35% of amyloidosis program respondents reported some degree of concern, compared with 50% of kidney transplant program respondents (Figure 8B). Among kidney transplant program respondents, 40% were sufficiently concerned about high-dose melphalan and autologous stem cell transplantation to indicate that they would avoid its use unless there were no other options for treatment, whereas none of the amyloidosis program respondents reported that level of concern (Figure 8B). For both the amyloidosis and kidney transplant program respondents, the greatest degree of concern was with the use of lenalidomide-based treatment; 20% and 15% of amyloidosis and transplant program respondents, respectively, reported that lenalidomide should not be used after kidney transplantation (Figure 8C). Among the kidney transplant program respondents, 25% indicated not knowing enough about lenalidomide to answer the question, compared with 5% of amyloidosis program respondents (Figure 8C).

F8
Figure 8.:
Degree of concern, if anti-plasma cell therapy is required after kidney transplantation. For a treatment regimen that includes (A) proteasome inhibitor, (B) high-dose melphalan with autologous stem cell transplantation, and (C) lenalidomide.

Discussion

Our survey of amyloidosis and kidney transplantation programs suggests that, while there are some areas of general agreement, overall there is a lack consensus across these specialties about criteria for kidney transplantation for patients with AL amyloidosis. Both groups conveyed views that there is less certainty about outcomes after kidney transplantation for patients with AL amyloidosis than for those with other causes of kidney failure, and that there is not a high degree of agreement among kidney transplant physicians about appropriate criteria for kidney transplantation for this patient population. Both groups considered anticipated patient survival and potential deleterious effects of post-transplant immunosuppression as the most important and least important factors, respectively, for determining kidney transplant suitability. However, compared with transplant programs, amyloidosis programs reported a higher confidence level in determining suitability for transplant, preferred to proceed with kidney transplantation earlier for patients who were in complete hematologic remission, were less concerned about extrarenal amyloid involvement as a determinant of transplant suitability, and had less concern about use of autologous stem cell transplantation if anti–plasma cell therapy is needed after kidney transplantation.

There are several potential reasons for the differences in perspectives between the specialties. Transplant physicians may be more cautious about proceeding with kidney transplantation because of (1) limited experience with AL amyloidosis given the rare nature of the disease, (2) historically poor outcomes for this patient population before relatively recent advances in anti–plasma cell therapies, and (3) the importance of post-transplant patient and allograft outcomes for maintaining program certification by payers (1112–13). Amyloidosis clinicians likely have a higher level of comfort monitoring for and managing hematologic relapses or extrarenal manifestations, and may be more aware than are transplant physicians, of the pace of development of new treatments for AL amyloidosis.

Most of the data on patient and allograft outcomes with kidney transplantation for patients with AL amyloidosis come from an era when the treatment of AL amyloidosis was much less effective than it is currently (1415161718–19). More recent studies indicate that outcomes have improved. A United States registry-based, retrospective, propensity-matched analysis found no significant difference in risk of death or allograft loss when patients with amyloidosis received a kidney transplant compared with other high-risk subgroups, such as older individuals or those with diabetes-associated kidney failure (20). A single-center prospective study found that, among the selected group of patients who underwent kidney transplantation, median patient survival after transplantation was 10.5 years, and 1-, 3-, and 5-year graft survivals were 94%, 89%, and 81%, respectively (9). In that study, outcomes were better among patients who had a complete or very good partial hematologic response before transplantation compared with those with either partial or no response, with median patient survivals of 11.7 and 7 years, respectively, and median allograft survivals of 10.4 and 5.5 years, respectively (9). A recent analysis that included patients receiving kidney transplants as far back as 1989 found that, for both patient and allograft survival, outcomes for patients with AL amyloidosis were similar to those with diabetic nephropathy (21). The findings of these analyses may not have been widely disseminated at the time our surveys were completed.

A recent consensus expert opinion report addressing organ transplantation in the setting of hematologic malignancies and melanoma includes a statement that kidney (or other single-organ) transplantation is possible in AL amyloidosis in selected circumstances; specifically, when there is a difference between the concenrations of involved and uninvolved serum free light chains of <4 mg/dl, single organ involvement, absence of symptomatic myeloma, and candidacy for autologous stem cell transplant after organ transplantation (22). The report does not address several of the issues included in our survey, such as timing of organ transplantation with respect to attainment of the hematologic response, or the specific treatment that led to the hematologic response. Responses to our survey suggest that many transplant and amyloidosis physicians favor less-stringent criteria than those put forward in the expert opinion report.

Strengths of our study include the inclusion of most of the major amyloidosis programs in the United States and the within-group consistency of the responses, suggesting that respondents interpreted the question and answer options similarly. Our study also has limitations. The low response rate among the kidney transplant programs raises concerns about generalizability. Of note, physician responses to surveys are typically low (23). The relatively high response rate among amyloidosis programs may reflect the commitment of clinicians treating patients with rare diseases to share their views with the larger clinical community. A second limitation is that the sample size is not sufficient to identify associations between characteristics of the programs, such as level of experience, and approaches to determining transplant eligibility. It is possible that there would be more agreement between amyloidosis and transplant programs if we had restricted our survey to programs with substantial experience with kidney transplantation in AL amyloidosis. Additionally, our surveys did not incorporate daratumumab, a monoclonal antibody directed against the CD38 plasma cell surface molecule, as a treatment option. Daratumumab was not in common use at the time the survey was initiated, but is now used frequently, often as first-line therapy, having recently received regulatory approval for the treatment of AL amyloidosis (24). It is possible that responses to some of the questions would be different if the survey had been administered after clinicians had more experience with daratumumab as a treatment option for use either before or after kidney transplantation.

In conclusion, we found several areas in which agreement is lacking between transplant and amyloidosis specialists about suitability for kidney transplantation in AL amyloidosis. With advances in anti–plasma cell therapies, and resultant improvements in patient survival, consideration for kidney transplantation among this patient population will likely increase. The findings from our survey should inform future efforts to generate consensus-based criteria for kidney transplantation in AL amyloidosis–associated kidney failure and suggest that there is a need for more interaction between amyloidosis and transplant specialists.

Disclosures

L.M. Dember reports receiving consulting fees from AstraZeneca, Cara Therapeutics, and Merck; and compensation from the National Kidney Foundation for her role as Deputy Editor of the American Journal of Kidney Diseases. All remaining authors have nothing to disclose.

Funding

None.

Acknowledgments

The authors would like to thank the survey respondents.

Author Contributions

L.M. Dember provided supervision and was responsible for project administration; L.M. Dember and R. Lam wrote the original draft and were responsible for formal analysis, investigation, and methodology; L.M. Dember and M.A. Lim reviewed and edited the manuscript; R. Lam was responsible for data curation and visualization; and all authors conceptualized the study.

Supplemental Material

This article contains supplemental material online at http://kidney360.asnjournals.org/lookup/suppl/doi:10.34067/KID.0004232021/-/DCSupplemental.

Supplemental Figure 1. Comfort with answering survey questions.

Supplemental Figure 2. Number of patients with amyloidosis evaluated for kidney transplantation during the past 3 years.

Supplemental Figure 3. Confidence in evaluating kidney transplantation suitability for patients with AL amyloidosis.

Supplemental Figure 4. Minimum expected life expectancy for kidney transplantation suitability.

Supplemental Figure 5. Earliest acceptable time for kidney transplantation if there is ongoing evidence of a partial hematologic response after autologous stem cell transplantation for AL amyloidosis.

Supplemental Appendix 1. Amyloidosis program survey.

Supplemental Appendix 2. Kidney transplant program survey.

References

1. Dember LM: Amyloidosis-associated kidney disease. J Am Soc Nephrol 17: 3458–3471, 2006 https://doi.org/10.1681/ASN.2006050460
2. Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B, Quellard N, Lacombe C, Goujon JM, Lavergne D, Abraham J, Touchard G, Fermand JP, Jaccard A; Centre national de référence pour l’amylose AL et les autres maladies par dépôts d’immunoglobulines monoclonales: Al amyloidosis. Orphanet J Rare Dis 7: 54, 2012 https://doi.org/10.1186/1750-1172-7-54
3. Quock TP, Yan T, Chang E, Guthrie S, Broder MS: Epidemiology of AL amyloidosis: A real-world study using US claims data. Blood Adv 2: 1046–1053, 2018 https://doi.org/10.1182/bloodadvances.2018016402
4. Merlini G, Seldin DC, Gertz MA: Amyloidosis: Pathogenesis and new therapeutic options. J Clin Oncol 29: 1924–1933, 2011 https://doi.org/10.1200/JCO.2010.32.2271
5. Cibeira MT, Sanchorawala V, Seldin DC, Quillen K, Berk JL, Dember LM, Segal A, Ruberg F, Meier-Ewert H, Andrea NT, Sloan JM, Finn KT, Doros G, Blade J, Skinner M: Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation: Long-term results in a series of 421 patients. Blood 118: 4346–4352, 2011 https://doi.org/10.1182/blood-2011-01-330738
6. Warsame R, LaPlant B, Kumar SK, Laumann K, Perez Burbano G, Buadi FK, Gertz MA, Kyle RA, Lacy MQ, Dingli D, Leung N, Hayman SR, Kapoor P, Hwa YL, Fonder A, Hobbs M, Gonsalves WI, Kourelis T, Lust J, Russell SJ, Zeldenrust S, Lin Y, Muchtar E, Go RS, Vincent Rajkumar S, Dispenzieri A: Long-term outcomes of IMiD-based trials in patients with immunoglobulin light-chain amyloidosis: A pooled analysis. Blood Cancer J 10: 4, 2020 https://doi.org/10.1038/s41408-019-0266-9
7. Palladini G, Sachchithanantham S, Milani P, Gillmore J, Foli A, Lachmann H, Basset M, Hawkins P, Merlini G, Wechalekar AD: A European collaborative study of cyclophosphamide, bortezomib, and dexamethasone in upfront treatment of systemic AL amyloidosis. Blood 126: 612–615, 2015 https://doi.org/10.1182/blood-2015-01-620302
8. Kastritis E, Palladini G, Minnema MC, Wechalekar AD, Jaccard A, Lee HC, Sanchorawala V, Gibbs S, Mollee P, Venner CP, Lu J, Schönland S, Gatt ME, Suzuki K, Kim K, Cibeira MT, Beksac M, Libby E, Valent J, Hungria V, Wong SW, Rosenzweig M, Bumma N, Huart A, Dimopoulos MA, Bhutani D, Waxman AJ, Goodman SA, Zonder JA, Lam S, Song K, Hansen T, Manier S, Roeloffzen W, Jamroziak K, Kwok F, Shimazaki C, Kim JS, Crusoe E, Ahmadi T, Tran N, Qin X, Vasey SY, Tromp B, Schecter JM, Weiss BM, Zhuang SH, Vermeulen J, Merlini G, Comenzo RL; ANDROMEDA Trial Investigators: Daratumumab-based treatment for immunoglobulin light-chain amyloidosis. N Engl J Med 385: 46–58, 2021 https://doi.org/10.1056/NEJMoa2028631
9. Angel-Korman A, Stern L, Sarosiek S, Sloan JM, Doros G, Sanchorawala V, Havasi A: Long-term outcome of kidney transplantation in AL amyloidosis [published correction appears in Kidney Int 96: 796, 2019]. Kidney Int 95: 405–411, 2019 https://doi.org/10.1016/j.kint.2018.09.021
10. Scientific Registry of Transplant Recipients: Transplant center search results. Available at: https://www.srtr.org/transplant-centers/?organ=kidney. Accessed September 22, 2021
11. Bollée G, Guery B, Joly D, Snanoudj R, Terrier B, Allouache M, Mercadal L, Peraldi MN, Viron B, Fumeron C, Elie C, Fakhouri F: Presentation and outcome of patients with systemic amyloidosis undergoing dialysis. Clin J Am Soc Nephrol 3: 375–381, 2008 https://doi.org/10.2215/CJN.02470607
12. Huang X, Wang Q, Jiang S, Chen W, Zeng C, Liu Z: The clinical features and outcomes of systemic AL amyloidosis: A cohort of 231 Chinese patients. Clin Kidney J 8: 120–126, 2015 https://doi.org/10.1093/ckj/sfu117
13. Woodside KJ, Sung RS: Do federal regulations have an impact on kidney transplant outcomes? Adv Chronic Kidney Dis 23: 332–339, 2016 https://doi.org/10.1053/j.ackd.2016.09.001
14. Pasternack A, Ahonen J, Kuhlbäck B: Renal transplantation in 45 patients with amyloidosis. Transplantation 42: 598–601, 1986 https://doi.org/10.1097/00007890-198612000-00005
15. Bleyer AJ, Donaldson LA, McIntosh M, Adams PL: Relationship between underlying renal disease and renal transplantation outcome. Am J Kidney Dis 37: 1152–1161, 2001 https://doi.org/10.1053/ajkd.2001.24516
16. Sherif AM, Refaie AF, Sobh MA, Mohamed NA, Sheashaa HA, Ghoneim MA: Long-term outcome of live donor kidney transplantation for renal amyloidosis. Am J Kidney Dis 42: 370–375, 2003 https://doi.org/10.1016/S0272-6386(03)00676-0
17. Sattianayagam PT, Gibbs SD, Pinney JH, Wechalekar AD, Lachmann HJ, Whelan CJ, Gilbertson JA, Hawkins PN, Gillmore JD: Solid organ transplantation in AL amyloidosis. Am J Transplant 10: 2124–2131, 2010 https://doi.org/10.1111/j.1600-6143.2010.03227.x
18. Pinney JH, Lachmann HJ, Sattianayagam PT, Gibbs SD, Wechalekar AD, Venner CP, Whelan CJ, Gilbertson JA, Rowczenio D, Hawkins PN, Gillmore JD: Renal transplantation in systemic amyloidosis-importance of amyloid fibril type and precursor protein abundance. Am J Transplant 13: 433–441, 2013 https://doi.org/10.1111/j.1600-6143.2012.04326.x
19. Herrmann SM, Gertz MA, Stegall MD, Dispenzieri A, Cosio FC, Kumar S, Lacy MQ, Dean PG, Prieto M, Zeldenrust SR, Buadi FK, Russell SJ, Nyberg SL, Hayman SR, Dingli D, Fervenza FC, Leung N: Long-term outcomes of patients with light chain amyloidosis (AL) after renal transplantation with or without stem cell transplantation. Nephrol Dial Transplant 26: 2032–2036, 2011 https://doi.org/10.1093/ndt/gfr067
20. Sawinski D, Lim MA, Cohen JB, Locke JE, Weiss B, Hogan JJ, Dember LM: Patient and kidney allograft survival in recipients with end-stage renal disease from amyloidosis. Transplantation 102: 300–309, 2018 https://doi.org/10.1097/TP.0000000000001930
21. Law S, Cohen O, Lachmann HJ, Rezk T, Gilbertson JA, Rowczenio D, Wechalekar AD, Hawkins PN, Motallebzadeh R, Gillmore JD: Renal transplant outcomes in amyloidosis. Nephrol Dial Transplant 36: 355–365, 2021 https://doi.org/10.1093/ndt/gfaa293
22. Al-Adra DP, Hammel L, Roberts J, Woodle ES, Levine D, Mandelbrot D, Verna E, Locke J, D’Cunha J, Farr M, Sawinski D, Agarwal PK, Plichta J, Pruthi S, Farr D, Carvajal R, Walker J, Zwald F, Habermann T, Gertz M, Bierman P, Dizon DS, Langstraat C, Al-Qaoud T, Eggener S, Richgels JP, Chang GJ, Geltzeiler C, Sapisochin G, Ricciardi R, Krupnick AS, Kennedy C, Mohindra N, Foley DP, Watt KD: Preexisting melanoma and hematological malignancies, prognosis, and timing to solid organ transplantation: A consensus expert opinion statement. Am J Transplant 21: 475–483, 2021 https://doi.org/10.1111/ajt.16324
23. Keating NL, Zaslavsky AM, Goldstein J, West DW, Ayanian JZ: Randomized trial of $20 versus $50 incentives to increase physician survey response rates. Med Care 46: 878–881, 2008 https://doi.org/10.1097/MLR.0b013e318178eb1d
24. US Food and Drug Administration: FDA grants accelerated approval to Darzalex Faspro for newly diagnosed light chain amyloidosis. Available at: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-darzalex-faspro-newly-diagnosed-light-chain-amyloidosis. Accessed January 15, 2021
Keywords:

glomerular and tubulointerstitial diseases; AL amyloidosis; amyloidosis; immunoglobulin light-chain amyloidosis; kidney transplantation; paraprotein-associated kidney disease; physicians; plasma cell disorder; stem cell transplantation; surveys and questionnaires

Copyright © 2021 by the American Society of Nephrology