Observational analysis suggests individualized kidney transplantation approaches in MGRS patients, indicating varying risks based on disease type and patient factors.
Monoclonal gammopathy of renal significance (MGRS) defines disorders characterized by direct or indirect kidney injury caused by a monoclonal immunoglobulin produced by a B cell or plasma cell clone that does not meet current hematologic criteria for therapy. There are numerous MGRS-associated kidney diseases and these can result in the development of end stage kidney disease. As recurrence has been reported for all MGRS-associated kidney diseases, the current paradigm states that the underlying hematologic condition should be treated, and a complete or very good partial response should be obtained before kidney transplantation can be performed. However, based on a critical analysis of recent literature, we suggest that decisions regarding kidney transplantation in MGRS patients should be individualized considering the type of MGRS-associated kidney disease, patient age and comorbidity, underlying hematologic disorder, the risk to develop a hematological malignancy, presence and risk of extrarenal complications, estimated waiting time, the availability of a living kidney donor, availability of effective treatment and previous hematological treatment and response.
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Sprangers et al. (2025) studied this question.
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