We report the five year outcome of nine patients with dialysis-related
amyloid (DRA) who underwent successful
renal transplantation (RT) and six patients who remained on
hemodialysis (HD).
Amyloid bone cysts, a radiologic feature of DRA, and scintigraphy with 123I-labeled
serum amyloid P component (SAP), a specific technique for evaluating
amyloid deposits in vivo, were monitored and compared with clinical features. In all HD patients there was clinical, scintigraphic and/or radiologic evidence that DRA progressed. In contrast, eight of the RT patients experienced profound early relief of DRA symptoms following
transplantation that persisted throughout follow-up, despite the reduction or withdrawal of
corticosteroids.
Amyloid bone cysts improved in four patients and SAP scans demonstrated regression of articular
amyloid in eight out of nine cases. The modest radiographic improvement suggests that
amyloid is mobilized more slowly in
bone cysts than elsewhere or that cystic bone is remodeled poorly. This is the first objective evidence that DRA regresses following
renal transplantation, and suggests that this may contribute to the long-term relief of DRA symptoms in transplant recipients who discontinue
corticosteroids.