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Article Dans Une Revue American Journal of Kidney Diseases Année : 2023

Kidney Transplantation in Patients With AA Amyloidosis: Outcomes in a French Multicenter Cohort

Olivier Marion
  • Fonction : Auteur
Amaury Dujardin
  • Fonction : Auteur
Sébastien Cuozzo
  • Fonction : Auteur
Arwa Jalal-Eddine
  • Fonction : Auteur
Tristan de Nattes
  • Fonction : Auteur
Claire Geneste
  • Fonction : Auteur
Eric Thervet
  • Fonction : Auteur
Didier Ducloux
  • Fonction : Auteur
Valentin Mayet
  • Fonction : Auteur
Raphaël Kormann
  • Fonction : Auteur
Antoine Lanot
  • Fonction : Auteur
Agnès Duveau
  • Fonction : Auteur
Mohamad Zaidan
  • Fonction : Auteur
Laurent Mesnard
  • Fonction : Auteur
Nacera Ouali
  • Fonction : Auteur
Eric Rondeau
  • Fonction : Auteur
Camille Petit-Hoang
  • Fonction : Auteur
Vincent Audard
  • Fonction : Auteur
Aurélie Deshayes
  • Fonction : Auteur
Anissa Moktefi
  • Fonction : Auteur
Marion Rabant
  • Fonction : Auteur
David Buob
  • Fonction : Auteur
Hélène François
  • Fonction : Auteur
Yosu Luque

Résumé

Rationale & Objective Outcomes of kidney transplantation for patients with renal AA amyloidosis are uncertain, with reports of poor survival and high rates of disease recurrence. However, data are inconclusive and mostly based on studies from the early 2000s and earlier. Study Design Retrospective multicenter cohort study. Setting & Participants We searched the French national transplant database to identify all patients with renal AA amyloidosis who underwent kidney transplantation between 2008 and 2018. Exposures Age, cause of amyloidosis, use of biotherapies, CRP levels. Outcomes 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. Analytical Approach The Kaplan-Meier estimator for mortality and the 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. Results Eighty-six patients who received kidney transplants for AA amyloidosis at 26 French centers were included. The median age was 49.4 years (interquartile range 39.7-61.1). The main cause of amyloidosis was Familial Mediterranean Fever (37 cases, 43%). Sixteen (18.6%) patients received a biotherapy after transplantation. Patient survival was 94.0% (95% confidence interval 89.1-99.2) at 1 year and 85.5% (77.8-94.0) at 5 years post-transplantation. The cumulative incidence of allograft loss was 10.5% (4.0-17.0) at 1 year, and 13.0% (5.8-20.1) at 5 years post-transplantation. Histologically proven AA amyloidosis recurrence occurred in 5 transplants (5.8%). 55.8% of cases developed an infection requiring hospitalization and 27.9% acute allograft rejection. Multivariable analysis showed that CRP concentration at the time of transplantation was associated with patient survival (HR 1.01, 95% CI 1.00-1.02, p=0.01) and with allograft survival (HR 1.68, 95% CI 1.10-2.57, p 0.02). Limitations The study lacked a control group and the effect of biotherapies on transplantation outcomes could not be explored. Conclusions 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.

Dates et versions

hal-04220868 , version 1 (28-09-2023)

Identifiants

Citer

Chloë Schwarz, Sophie Georgin-Lavialle, Yannis Lombardi, Olivier Marion, Frédéric Jambon, et al.. Kidney Transplantation in Patients With AA Amyloidosis: Outcomes in a French Multicenter Cohort. American Journal of Kidney Diseases, 2023, ⟨10.1053/j.ajkd.2023.07.020⟩. ⟨hal-04220868⟩
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