Natural History and Post-transplant Outcomes Among Patients with Kidney Leukocyte Cell-Derived
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Introduction
ALECT2 is the third most common cause of renal amyloidosis in the United States, with a strong predilection for Hispanic patients in the Southwest. (PMID:24522497) Despite its regional prevalence, data on the trajectory of kidney function decline and post-transplant outcomes remain poorly characterized.
Methods
This is a retrospective study of patients diagnosed with ALECT2 by kidney biopsy at UNM from January 2014 to April 2024. Pre- and post-biopsy eGFR trajectories and post-transplant allograft function were analyzed.
Results
Twelve patients had pre-biopsy data available, with a mean age at diagnosis of 64 ± 12.0 years; 8 (67%) were female, and 8 identified as Hispanic. Mean eGFR at diagnosis was 31 (SD 29), indicating advanced kidney disease, with 67% diagnosed as CKD stage 4 or 5. Concomitant kidney pathology was identified in 50% of patients, with diabetic nephropathy present in two-thirds of those cases. A significant change in the eGFR trajectory was identified at the time of biopsy through change-point analysis [Figures A, C, D]. Among the four patients who underwent kidney transplantation, allograft eGFR remained stable over more than 60 months of follow-up [Figure D].
Conclusion
In this cohort of predominantly Hispanic patients, ALECT2 amyloidosis presented with advanced CKD and accelerated loss of kidney function, which prompted a biopsy that detected the disease. Post-transplant allograft function was well maintained, supporting kidney transplantation as a viable treatment strategy for ALECT2-associated kidney disease.
