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Tan SY, Irish A, Winearls CG, Brown EA, et al.
Long term effects of renal transplantation on dialysis-related amyloid deposits and symptomatology
Kidney Int (Jul) 50:282-289 1996
In 1990 members of this group described a technique in NEJM to evaluate the extent of dialysis-related amyloidosis (DRA) using 123-I-labeled serum amyloid P component. They now use this technique, plus clinical and radiologic assessment, to determine what happens to DRA after renal transplantation.
Fifteen long term (18 years median) HD patients were studied prospectively over 5 years, during which time 9 were transplanted. In the transplanted group there was marked clinical, scintigraphic, and mild radiographic improvement, whereas in the non-transplanted group there was considerable progression of disease. SAP scintigraphy was found to be useful to detect silent amyloid disease.
Comment: The results are significant in that they suggest that even severe DRA is potentially reversible, certainly with transplantation, and possibly with very high flux hemodiafiltration (although the latter remains to be more thoroughly investigated). (John T. Daugirdas, MD, University of Illinois at Chicago)
