Thread by @kdjhaveri

1. Here is short tweet summary of our analysis of myeloma patients on dialysis that received a renal transplant and their outcomes @NDTsocial @vinaynairdo @renalmyeloma @DrMHB1 @MersemaA academic.oup.com/ndt/advance-ar…

2. Most data regarding outcomes of kidney transplantation in patients with myeloma come from single center case series. With the advent of novel treatment choices, it remains unclear if outcomes of kidney transplant recipients with myeloma have improved in last decade

3.Literature reviews for multiple myeloma or smoldering MM with kidney transplantation were performed. Case series with at least one kidney transplant recipient with a history of multiple myeloma were included.

4.Variables and outcomes including: demographics, cause of ESKD, treatment for MM, time from treatment
to transplant, type of transplant, induction immunosuppression, relapse episodes, time to relapse, de
novo malignancies, graft loss, death censored graft loss, and death.

5. Baseline demo

6. Outcomes

7. At the end of the follow up period, 25 (69%) were alive, of which 21 (58%) had a functioning kidney allograft. Eleven patients (31%) had died (9 with functioning kidney allograft).

8. Median time from treatment of MM to death and death censored graft loss was 49 months (IQR 37-80) and 31 months. The median duration from the most recent treatment of MM to kidney transplant was 58 months in those who died vs 36 months in those who survived (p=0.27)

9. We found death-censored graft loss occurred in 17% of patients, where half lost their graft due to rejection, highlighting the difficult balance between maintaining adequate IST for the kidney transplant without resulting in overimmunosuppression.

10. This is an area of unmet need for MM patients with the main comorbidity being ESKD.

11. Clearly, based on this data, there are select MM patients who would benefit from transplant in this setting. Selection of the optimal MM patient with ESKD for kidney transplant requires further investigation.