Nephrol Dial Transplant (1996) 11: 2461-2465
© 1996 European Renal Association-European Dialysis and Transplant Association
research-article
Monoclonal gammopathy after intense induction immunosuppression in renal transplant patients
Division of Nephrology and Organ Transplantation, Department of Internal Madicine Kantonsspital Basel, Switzerland
Correspondence and offprint requests to: Correspondence and offprint requests to: H. A. Bock MD, Division of Nephrology, Kantonsspital, CH-4031 Basel, Switzerland
OBJECTIVES.: Incidence and risk factors of post-transplant monoclonal gammopathy were studied in renal transplant patients who received their grafts between 1982 and 1992 (n=390 grafts). Immunoelectrophoresis was performed at annual intervals after transplantation.
RESULTS.: Forty-six cases of clonal gammopathy were detected: 35 monoclonal, 11 bi- or triclonal, with a predominance of IgG and K light-chain subtypes (IgG, 39; IgA, 3; IgM, 4; K, 35; 
, 19). Gammopathy was transient in 17 patients (37%). The 5-year cumulative incidence of gammopathy was 10.7%, much higher than expected for a group of similar age from the general population. Thirty of the 46 gammopathies appeared within the first 2 years of transplantation. Gammopathy never progressed to multiple myeloma during follow-up (median 1 year; (range 0–10)); one patient subsequently developed Kaposi sarcoma. The 2-year incidence of gammopathy was much higher in patients transplanted in 1989–1991 (23/142) than in 1982–1988 (7/248) (P<0.0001). This coincided with the use of quadruple induction immunosuppression (cyclosporin A+azathioprine+prednisone plus either ATG-Fresenius (ATG-F) or OKT3) since 1989. The risk for acquiring gammopathy within 2 years of transplantation was 14.7% (95% CI 9.2, 20.3%) in patients receiving quadruple induction therapy, but only 3.0% (CI 1.2, 6.1%) without such therapy (P<0.0001). The risk for patients receiving quadruple immunosuppression with OKT3 was 24.5%, significantly greater than with ATG-F (11.8%, P<0.05). Discriminant analysis revealed that the type of immunosuppression, but not age or year of transplantation, were independent risk factors for gammopathy.
CONCLUSIONS.: Monoclonal gammopathy frequently occurs after renal transplantation. Risks are higher for patients receiving quadruple induction immunosuppression, particularly if it includes OKT3. Follow-up of these patients is warranted for the early detection of malignant transformation.
Keywords: monoclonal gammopathy; kidney transplantation; prophylactic immunosuppression; monoclonal antibodies; polyclonal antibodies
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. Knoll, S. Cockfield, T. Blydt-Hansen, D. Baran, B. Kiberd, D. Landsberg, D. Rush, E. Cole, and for The Kidney Transplant Working Group of the Can Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation Can. Med. Assoc. J., November 8, 2005; 173(10): S1 - S25. [Full Text] [PDF]
|
|