Can a person with localized amyloidosis (a condition characterized by abnormal protein deposits) and a 6-year follow-up transmit subclinical amyloid disease to a kidney recipient through donation?

Kidney Donation with Localized Amyloidosis: Risk Assessment for Transmission

A person with localized amyloidosis and a 6-year follow-up without progression can safely donate a kidney with minimal risk of transmitting subclinical amyloid disease to the recipient. 1

Understanding Localized vs. Systemic Amyloidosis

• Localized amyloidosis involves deposition of amyloid protein in a single organ or tissue without systemic involvement, likely resulting from local synthesis of amyloid protein rather than deposition from elsewhere 2
• In contrast, systemic amyloidosis (like AL or ATTR types) affects multiple organs including the heart and kidneys, with different protein precursors forming amyloid fibrils 1
• Long-term follow-up studies (mean 7.6 years) have shown that patients with localized amyloidosis do not develop systemic disease, supporting the hypothesis of local production of amyloid protein 2

Risk Assessment for Kidney Donation

• The primary concern in amyloidosis is the risk of recurrence in transplanted organs, which applies to systemic disease but not to truly localized forms 1
• A 6-year follow-up without progression to systemic disease provides strong evidence that the amyloidosis is truly localized and stable 1, 2
• Localized amyloidosis has been documented in various organ systems including skin, soft tissues, oropharynx, larynx, lung, bladder, colon, conjunctiva, and lymph nodes - with kidney involvement typically seen only in systemic forms 2

Pre-Donation Evaluation Recommendations

• Comprehensive evaluation should confirm the amyloidosis remains localized through:
  • Screening for proteinuria and assessment of kidney function using cystatin C-based GFR measurements 1
  • Evaluation for any signs of cardiac involvement, which would suggest systemic disease 1
  • Standard protocols for living donors with special attention to ruling out subclinical kidney involvement 1

Evidence Supporting Safety

• Studies of kidney transplantation in patients with amyloidosis have shown good outcomes, with 5-year patient and graft survival rates of 84.3% and 68.7%, respectively 3
• Recurrence of amyloidosis in transplanted kidneys is primarily a concern with systemic forms like AA amyloidosis, especially when the underlying inflammatory condition is active 4
• The absence of progression to systemic disease over a 6-year period significantly reduces the risk of transmission through kidney donation 2

Monitoring Recommendations

• The donor should receive regular follow-up after donation, including periodic assessment for proteinuria and kidney function 1
• While the theoretical risk of localized amyloidosis progressing to systemic disease exists, long-term studies suggest this is extremely unlikely after a stable 6-year period 2
• Standard post-donation monitoring protocols are sufficient, as they would detect any changes in kidney function that might suggest progression 1

Conclusion

The evidence strongly supports that a donor with localized amyloidosis and a stable 6-year follow-up presents minimal risk of transmitting amyloid disease to the recipient. The localized nature of the disease, combined with the extended period without progression, indicates that kidney donation can proceed safely with standard donor evaluation and monitoring protocols.