Ask the Experts - Kidney Transplant in Patient With Myeloma?
Should patients with multiple myeloma receive a renal transplant, and, if yes, what is the prognosis and the specific management of such transplanted patients? And if no, why not?
Liviu Segall, PhD
Conventionally, the only absolute contraindications to renal transplantation are untreated malignancy and acute infection. However, in the case of multiple myeloma, there is a case report from the Massachusetts General Hospital of combined kidney/bone marrow transplantation using an HLA-identical sibling and a nonmyeloablative conditioning technique. Although sustained peripheral and marrow microchimerism was not obtained, the recipient remained myeloma-free, with normal kidney function, off all immunosuppression. If this successful case can be replicated, it may be possible to transplant patients with myeloma and renal failure successfully, using this carefully defined model. It should be emphasized that this success was achieved in the setting of a collaboration at a single institution among a number of groups of individuals with tremendous expertise in a number of areas and should not be attempted casually.