TRANSPLANTATION IN RENAL AMYLOIDOSIS

In this report, the results of renal transplantation in patients with renal amyloidosis were retrospectively analysed and compared with the control group. Fifteen (3.04%) of the 493 renal transplant recipients whom were followed up in Istanbul School of Medicine transplant outpat ient clinic. between 1983 and 1997, were included in the study. The et iology of amyloidosis was familial Mediterranean fever in all patients . The mean follow-up period was 38.3 +/- 31.8 (range 7-65) months. Twe lve of the patients were male and 3 female with the mean age 34.13 +/- 10.87 (range 21-60) years. Seven patients had living related, 3 livin g-unrelated and 4 cadaveric donors. Five patients were lost because of different complications: Three patients died from cardiac amyloidosis all with well functioning grafts, 2, 3 and 36 months after the operat ion. sepsis and cardiovascular failure was the probable cause of death in 1 patient who also had chronic rejection. Another one patient with chronic rejection died from hepatic failure, acute rejection develope d in 2 patients, Renal functions of these patients improved by anti-re jection therapies. Chronic rejection developed in 3 patients. In the c ontrol group. acute rejection and chronic rejection were diagnosed in 5 and 1 patients, retrospectively. While 1 patients returned to hemodi alysis in control group, the others are alive with satisfactory graft function. There was no death in control group. The 5-yr graft and pati ent survival rates in amyloidosis and the control groups were 75, 77, 95 and 100%, respectively. It was concluded that although transplantat ion is not a contraindication for the treatment of end stage renal fai lure in patients with renal amyloidosis, it carries high risk of cardi ac complications in the postoperative period. Detailed preoperative ca rdiovascular evaluations are mandatory in these patients and this inte rvention should improve the prognosis by excluding the patients who ha ve already been complicated with this problem.