Czarnecki PG et al. (2008) Long-term outcome of kidney transplantation in patients with fibrillary glomerulonephritis or monoclonal gammopathy with fibrillary deposits. Kidney Int [doi:10.1038/ki.2008.577]

Fibrillary glomerulonephritis (FGN) is rare; as a result, few data are available on the long-term outcomes of this disease after renal transplantation. Czarnecki and colleagues reviewed the outcomes of all patients with FGN or monoclonal gammopathy with fibrillary deposits (MGFD) who underwent kidney transplantation and protocol biopsies at the Mayo Clinic, Rochester, MN, between January 1988 and December 2007 (n = 5 and n = 7, respectively).

During follow-up (median 52 months), MGFD recurred in four individuals but FGN did not recur in any patient. Six grafts were lost in the MGFD group (median graft survival 38 months) but only one graft was lost in the FGN group, as a result of graft thromboembolism. Three patients with MGFD required a second kidney transplantation; one lost the second graft to recurrence. Median time to graft failure after MGFD recurrence was 17 months (range 10–46 months). Two deaths occurred in the MGFD group, both of which were associated with hematological malignancies. Both of the patients with MGFD who retained their original allografts experienced recurrence but had stable graft function at final follow-up, although one individual required peripheral blood stem cell transplantation.

The authors conclude that kidney transplantation is a valid therapeutic option in patients with FGN, but that patients with MGFD should only be offered kidney transplantation if their hematological disease is in remission or can be treated to induce remission.