Renal transplantation for amyloid end-stage renal failure-insights from serial serum amyloid P component scintigraphy

Although end-stage renal failure (ESRF) is common in systemic amyloidosis, few such patients receive renal transplants. Serum amyloid P component (SAP ) scintigraphy is a specific method for the imaging and quantification of a myloid deposits in vivo, which has not previously been used to evaluate the outcome of renal transplantation in patients with amyloidosis. Evidence of renal graft amyloid was sought by SAP scintigraphy in 15 patients with sys temic amyloidosis who had undergone renal transplantation 42-216 months (me dian, 73 months) previously. Prospective serial scans were obtained annuall y in eight cases. Renal grafts studied shortly after transplantation gave b lood-pool images. The grafts remained normal in all patients whose underlyi ng amyloidogenic disorder had remitted, whereas there was abnormal uptake o f labelled SAP, indicating graft amyloidosis, in four out of 10 patients wh ose amyloid fibril precursor protein supply had not diminished. Graft amylo idosis was corroborated by renal dysfunction in each case, and by histology in one patient. SAP scintigraphy enables renal transplant grafts to be mon itored noninvasively for involvement by amyloid. The lack of graft amyloido sis in all patients in whom the amyloidogenic underlying disorder had remit ted, and in more than half of those in whom it had not, supports the use of renal transplantation for ESRF in systemic amyloidosis. ((C) 2000 Lippinco tt Williams & Wilkins).