Abstract：
Outcomes of kidney transplantation for patients with renal AA amyloidosis are uncertain, with reports of poor survival and high rates of disease recurrence. However, the data are inconclusive and mostly based on studies from the early 2000s and earlier.
Retrospective multicenter cohort study.
We searched the French national transplant database to identify all patients with renal AA amyloidosis who underwent kidney transplantation between 2008 and 2018.
Age, cause of amyloidosis, use of biotherapies, and C-reactive protein levels.
Outcomes were all-cause mortality and allograft loss. We also reported amyloidosis allograft recurrence, occurrence of acute rejection episodes, as well as infectious, cardiovascular, and neoplastic disease events.
Kaplan-Meier estimator for mortality and cumulative incidence function method for allograft loss. Factors associated with patient and allograft survival were investigated using a Cox proportional hazards model and a cause-specific hazards model, respectively.
86 patients who received kidney transplants for AA amyloidosis at 26 French centers were included. The median age was 49.4 years (IQR, 39.7-61.1). The main cause of amyloidosis was familial Mediterranean fever (37 cases; 43%). 16 (18.6%) patients received biotherapy after transplantation. Patient survival rates were 94.0% (95% CI, 89.1-99.2) at 1 year and 85.5% (77.8-94.0) at 5 years after transplantation. Cumulative incidences of allograft loss were 10.5% (4.0-17.0) at 1 year and 13.0% (5.8-20.1) at 5 years after transplantation. Histologically proven AA amyloidosis recurrence occurred in 5 transplants (5.8%). An infection requiring hospitalization developed in 55.8% of cases, and there was a 27.9% incidence of acute allograft rejection. Multivariable analysis showed that C-reactive protein concentration at the time of transplantation was associated with patient survival (HR, 1.01; 95% CI, 1.00-1.02; P=0.01) and allograft survival (HR, 1.68; 95% CI, 1.10-2.57; P=0.02).
The study lacked a control group, and the effect of biotherapies on transplantation outcomes could not be explored.
This relatively contemporary cohort of patients who received a kidney transplant for AA amyloidosis experienced favorable rates of survival and lower recurrence rates than previously reported. These data support the practice of treating these patients with kidney transplantation for end-stage kidney disease.
AA amyloidosis is a severe and rare disease. Kidney involvement is frequent and leads to end-stage kidney disease. Because of the involvement of other organs, these patients are often frail, which has raised concerns about their suitability for kidney transplantation. We reviewed all patients with AA amyloidosis nephropathy who underwent kidney transplantation in France in the recent era (2008-2018) and found that the outcomes after kidney transplantation were favorable, with 85.5% of patients still alive 5 years after transplantation, a survival rate that is comparable to the outcomes of patients receiving a transplant for other forms of kidney diseases. Recurrence of amyloidosis in the transplanted kidney was infrequent (5.8%). These data support the practice of kidney transplantation for patients with AA amyloidosis who experience kidney failure.
Retrospective multicenter cohort study.
We searched the French national transplant database to identify all patients with renal AA amyloidosis who underwent kidney transplantation between 2008 and 2018.
Age, cause of amyloidosis, use of biotherapies, and C-reactive protein levels.
Outcomes were all-cause mortality and allograft loss. We also reported amyloidosis allograft recurrence, occurrence of acute rejection episodes, as well as infectious, cardiovascular, and neoplastic disease events.
Kaplan-Meier estimator for mortality and cumulative incidence function method for allograft loss. Factors associated with patient and allograft survival were investigated using a Cox proportional hazards model and a cause-specific hazards model, respectively.
86 patients who received kidney transplants for AA amyloidosis at 26 French centers were included. The median age was 49.4 years (IQR, 39.7-61.1). The main cause of amyloidosis was familial Mediterranean fever (37 cases; 43%). 16 (18.6%) patients received biotherapy after transplantation. Patient survival rates were 94.0% (95% CI, 89.1-99.2) at 1 year and 85.5% (77.8-94.0) at 5 years after transplantation. Cumulative incidences of allograft loss were 10.5% (4.0-17.0) at 1 year and 13.0% (5.8-20.1) at 5 years after transplantation. Histologically proven AA amyloidosis recurrence occurred in 5 transplants (5.8%). An infection requiring hospitalization developed in 55.8% of cases, and there was a 27.9% incidence of acute allograft rejection. Multivariable analysis showed that C-reactive protein concentration at the time of transplantation was associated with patient survival (HR, 1.01; 95% CI, 1.00-1.02; P=0.01) and allograft survival (HR, 1.68; 95% CI, 1.10-2.57; P=0.02).
The study lacked a control group, and the effect of biotherapies on transplantation outcomes could not be explored.
This relatively contemporary cohort of patients who received a kidney transplant for AA amyloidosis experienced favorable rates of survival and lower recurrence rates than previously reported. These data support the practice of treating these patients with kidney transplantation for end-stage kidney disease.
AA amyloidosis is a severe and rare disease. Kidney involvement is frequent and leads to end-stage kidney disease. Because of the involvement of other organs, these patients are often frail, which has raised concerns about their suitability for kidney transplantation. We reviewed all patients with AA amyloidosis nephropathy who underwent kidney transplantation in France in the recent era (2008-2018) and found that the outcomes after kidney transplantation were favorable, with 85.5% of patients still alive 5 years after transplantation, a survival rate that is comparable to the outcomes of patients receiving a transplant for other forms of kidney diseases. Recurrence of amyloidosis in the transplanted kidney was infrequent (5.8%). These data support the practice of kidney transplantation for patients with AA amyloidosis who experience kidney failure.
摘要：
目的：肾性AA淀粉样变性患者的肾移植结果尚不确定，有低生存率和高复发率的报道。然而,数据尚无定论，主要基于21世纪初和更早的研究。
方法：回顾性多中心队列研究。
方法：我们搜索了法国国家移植数据库，以确定2008年至2018年期间接受肾脏移植的所有肾脏AA淀粉样变性患者。
方法：年龄，淀粉样变性的原因，使用生物疗法，CRP水平。
结果：结果是全因死亡率和同种异体移植物丢失。我们还报道了淀粉样变性同种异体移植物复发，急性排斥反应发作的发生，以及传染性，心血管,和肿瘤性疾病事件。
方法：死亡率的Kaplan-Meier估计法和同种异体移植物丢失的累积发生率函数法。使用Cox比例风险模型和特定原因风险模型研究了与患者和同种异体移植物存活相关的因素。分别。
结果：纳入了在26个法国中心接受AA淀粉样变性肾移植的86例患者。中位年龄为49.4岁（四分位距39.7-61.1）。淀粉样变性的主要原因是家族性地中海热（37例，43%）。16例（18.6％）患者在移植后接受了生物治疗。移植后1年患者生存率为94.0%（95%置信区间89.1-99.2），5年生存率为85.5%（77.8-94.0）。1年时同种异体移植物丢失的累积发生率为10.5％（4.0-17.0），移植后5年为13.0%(5.8-20.1)。经组织学证实的AA淀粉样变性复发发生在5例移植中(5.8%)。55.8％的病例发生了需要住院治疗的感染和27.9％的急性同种异体移植排斥反应。多变量分析表明，移植时的CRP浓度与患者生存率（HR1.01，95％CI1.00-1.02，p=0.01）和同种异体移植物生存率（HR1.68，95％CI1.10-2.57，p0.02）相关。
结论：该研究缺乏对照组，无法探索生物疗法对移植结局的影响。
结论：接受肾移植的AA淀粉样变性患者的这一相对当代的队列经历了比以前报道的更高的生存率和更低的复发率。这些数据支持对这些患者进行肾移植治疗终末期肾病的实践。
方法：回顾性多中心队列研究。
方法：我们搜索了法国国家移植数据库，以确定2008年至2018年期间接受肾脏移植的所有肾脏AA淀粉样变性患者。
方法：年龄，淀粉样变性的原因，使用生物疗法，CRP水平。
结果：结果是全因死亡率和同种异体移植物丢失。我们还报道了淀粉样变性同种异体移植物复发，急性排斥反应发作的发生，以及传染性，心血管,和肿瘤性疾病事件。
方法：死亡率的Kaplan-Meier估计法和同种异体移植物丢失的累积发生率函数法。使用Cox比例风险模型和特定原因风险模型研究了与患者和同种异体移植物存活相关的因素。分别。
结果：纳入了在26个法国中心接受AA淀粉样变性肾移植的86例患者。中位年龄为49.4岁（四分位距39.7-61.1）。淀粉样变性的主要原因是家族性地中海热（37例，43%）。16例（18.6％）患者在移植后接受了生物治疗。移植后1年患者生存率为94.0%（95%置信区间89.1-99.2），5年生存率为85.5%（77.8-94.0）。1年时同种异体移植物丢失的累积发生率为10.5％（4.0-17.0），移植后5年为13.0%(5.8-20.1)。经组织学证实的AA淀粉样变性复发发生在5例移植中(5.8%)。55.8％的病例发生了需要住院治疗的感染和27.9％的急性同种异体移植排斥反应。多变量分析表明，移植时的CRP浓度与患者生存率（HR1.01，95％CI1.00-1.02，p=0.01）和同种异体移植物生存率（HR1.68，95％CI1.10-2.57，p0.02）相关。
结论：该研究缺乏对照组，无法探索生物疗法对移植结局的影响。
结论：接受肾移植的AA淀粉样变性患者的这一相对当代的队列经历了比以前报道的更高的生存率和更低的复发率。这些数据支持对这些患者进行肾移植治疗终末期肾病的实践。
