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Kidney Transplant in Monoclonal Gammopathy

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Dr Divya Bajpai, Mumbai    29 November 2019

  • Advance in therapies for myeloma allows for successful kidney transplantation recipients (KTR) in selected patients.
  • Low-risk patients who achieve sustained minimal residual disease (MRD) negative status for >6 months after autologous stem cell transplant (SCT) can be considered for KTR; whereas, moderate-risk patients need more waiting time.
  • High-risk patients or those who are not MRD negative, are at high- risk of relapse post-KTR and should be counseled accordingly.
  • A novel approach, especially for high risk patients, is HLA identical allogenies SCT and kidney transplant from the same donor.
  • Patients with MGUS can undergo KTR with no significant increase in the risk of progression to MM and similar graft and patient survival, but require long-term follow-up.
  • A multidisciplinary approach with shared decision making amongst the patient, nephrologist, and hemato-oncologist is the key to success.

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