Systematic Review of Kidney Transplant Outcomes in Monoclonal Ig Deposition Disease

Introduction Historical case series of monoclonal Ig deposition disease (MIDD) after kidney transplantation (KTx) reported unfavorable outcomes. Recent case series support more acceptable outcomes in selected patients. Methods We performed a pooled analysis of case series and case reports using available individual participant data (IPD). We searched MEDLINE, Web of Science, SCOPUS, Cochrane Library, and gray literature. Recurrence-free survival, graft survival, and overall survival from the time of KTx were analyzed. Sensitivity analyses were performed according to publication type, hematologic response before KTx, exposure to novel agents, and era. Results Eighty-seven kidney allografts were included from case series and case reports between 1986 and 2023. During the median follow-up of 46 months, recurrence occurred in 47 allografts (54%), at a median of 30 months after KTx. The estimated median recurrence-free survival was significantly longer in patients who achieved a very good partial response (VGPR) hematologic response or better. Graft survival at 5- and 10-years was 67.1% and 45.9% respectively. Recurrence was the main cause of the graft loss in the majority. Among the patients who faced recurrence, the median time from recurrence to graft failure was longer in those who received clone-directed therapies (62 vs. 11 months, P = 0.02). Overall survival rates at 5 and 10 years were 83.8% and 47.4%, respectively. Conclusion More recent outcomes of patients with MIDD after KTx are favorable. Clone-directed therapies in recurrent disease appear to prolong graft survival.