Status:
Ready to upload
Record number:
2174
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for monoclonal gammopathy of undetermined significance (MGUS) (Council of Europe, 2022):
Monoclonal gammopathies of undetermined significance (MGUS) in the donor history: MGUS with accurate diagnosis and appropriate follow-up without progression to multiple myeloma or related disorders after a definite disease-free interval of 5-10 years may be considered for organ donation and be assumed to pose a low risk for transmission.
It might be reasonable to accept an organ donor with a pre-diagnosed MGUS, especially in cases of confirmed MGUS without progression where the diagnosis has been confirmed years before.
Time to detection:
Not applicable: Two recipients of living donor kidney transplants from donors with MGUS (monoclonal gammopathy of undetermined significance) showed no evidence of disease at 36 and 42 months following transplant.
Alerting signals, symptoms, evidence of occurrence:
None
Demonstration of imputability or root cause:
Not applicable
Imputability grade:
Not Assessable
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Case Report
Single Center Series
Living donor
Kidney transplant
Kidney recipient
Kidney transplantation
MGUS (monoclonal gammopathy of unknown significance)
Therapy not discussed
Reference attachment:
Suggest references:
Serra N, Revuelta I, Bladé J, Oppenheimer F, Campistol JM. Monoclonal gammopathy of undetermined significance: a contraindication for living kidney donation? NDT Plus. 2011 Aug;4(4):256-7. doi: 10.1093/ndtplus/sfr052. Epub 2011 Apr 12. PMID: 25949496; PMCID: PMC4421438.
Note:
Uploaded MN 5/8/22
First review MN 11/12/23
Second review CLFF 20/05/24 (agree to first review)
Expert comments for publication:
This report from 2011 predated any guidelines for consideration of donor MGUS in organ transplantation. The decision to transplant was based on multidisciplinary inputs; based on their results they no longer considered MGUS to contraindicate transplantation, and suggested establishment of protocols to optimize the approach.
They note that the risk for MGUS to evolve to myeloma is 1% per year, with the main risk factor being the serum M protein concentration. The concentration in donor 1 was 13.2 g/L (3% plasma cells in bone marrow) and in donor 2 it was 10 g/L (biclonal IgG kappa IgA lambda, 8% plasma cells in bone marrow). Neither donor had progressed at the time of the report.
One example of a recent review of MGUS discussing risk stratification is at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9720897/. Recent studies also incorporate additional biomarkers to aid in predicting progression (for example, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9991855/).