What is the role of renal transplantation in the treatment of light-chain deposition disease (LCDD)?

Updated: Sep 26, 2019
  • Author: Swapna Boppana, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

A few patients with LCDD with ESRD have undergone renal transplantation. [53]  Long-term benefits are seen, but allograft survival is significantly reduced in this patient population. [54] LCDD patients who have detectable light chains in urine or serum have worse outcomes, with early recurrences despite pretransplantation treatment. [55] Thus, transplantation should be reserved for select patients with a relatively slow course in whom light-chain production can be controlled by directed therapy.

Despite all careful consideration, recurrences develop and sometimes can be confused with acute rejection. A recent study with bortezomib in a single patient suggests that it can successfully reverse early recurrence of LCDD in the allograft. [56] Rituximab could also be considered for delaying early LCDD recurrence in patients in whom treatment of the underlying bone marrow disorder failed or is contraindicated, but maintenance therapy is apparently necessary to consolidate this response. [57] The possibility of maintenance with either bortezomib, thalidomide, or rituximab needs to be further explored.


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