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Malignancy that develops after kidney transplantation is a serious complication. The incidence is three to five times higher in comparison to that of the general population. Solid organ transplant patients have a higher incidence in plasma cell neoplasms what could significantly worsen allograft survival. The novelty of this report is that an example of diagnosis and treatment of AL-amyloidosis and multiple myeloma verified after kidney transplantation is presented.
60 y.o. woman suffered arterial hypertension for 10 years. The level of her creatinine began to rise in 2020 after Covid-19 infection. The patient also had proteinuria less than 1 g/day. She was diagnosed with primary nephroangiosclerosis and hemodialysis was started from April 2022. At that time she was put into a waiting list for kidney transplantation and passed all the examinations that did not detect any signs of plasma cell neoplasms and other diseases with paraproteins. Unfortunately, monoclonal protein detection is not routinely done and is not included in the clinical guideline for kidney transplantation in our country. The patient had kidney transplantation in March 2023. Standard immunosuppression triple therapy with prednisone, tacrolimus and mycophenolate mofetil was initiated. In 2 weeks kidney biopsy was performed due to delayed allograft function. Acute humoral vascular (2A) graft rejection was verified. Antithymocyte immunoglobulin 2 mg/кг for 7 days and pulse-therapy with steroids 500 mg/day for 3 days were used for treatment. Kidney transplant dysfunction was still present and the patient required hemodialysis. In 3 weeks after the first one a re-biopsy of the transplant was done. It revealed a decrease in the severity of humoral vascular graft rejection and the presence of tubular damage with amyloid deposits (positive staining with Congo red, see picture 1).
There is currently little evidence of an association between plasma cell neoplasms and kidney transplantation. Our case demonstrates that vigilance is required in this regard. The decision on the patient’s treatment and monitoring should be made by a team of specialists.