Table 4.

Kidney Transplant Candidate Criteria and Post-Transplant Management for Individuals with Plasma Cell Dyscrasias¹⁰⁹

Transplant Candidate Criteria
1. Living donor or estimated time to deceased donor transplant less than or equal to 2 years
2. No ABO incompatible donors or positive crossmatch
3. Confirmed CR or VGPR for 1 year post-ASCT
4. Bone marrow biopsy within 4 months of kidney transplant (within 1 year if deceased donor transplant)
5. PCD labs within 4 weeks of kidney transplant (within 6 months if deceased donor transplant)
6. Clearance by oncology
7. Fat pad biopsy and cardiac MRI to evaluate for amyloidosis
8. Kidney and bladder ultrasound to evaluate for GU malignancy
9. Hold IMiD for 4 weeks and proteasome inhibitor for 2 weeks pre-transplant (avoid regimens containing IMiDs if possible in deceased donor recipients)
Post-Transplant Management
1. Induction therapy for kidney transplant per PRA
2. Maintenance immunosuppressive regimen consisting of tacrolimus, mycophenolate, and prednisone. Lower dose mycophenolate after re-initiation of PCD-directed therapy
3. Use of PCP prophylaxis and HSV prophylaxis indefinitely due to increased state of immunosuppression from PCD-directed therapy
4. Preferentially treat with proteasome inhibitor or CD38 inhibitor for maintenance, restarting at 2-3 weeks post-transplant
5. More aggressive screening for malignancies including kidney/bladder ultrasound every 1-3 years to rule out urologic malignancy

Abbreviations: ASCT, autologous stem cell transplant; CR, complete response; GU, genitourinary; ImiD, imide; MRI, magnetic resonance imaging; PCD, plasma cell dyscrasia; PCP, pneumocystis pneumonia; PRA, panel reactive antibody; VGPR, very good partial response.