Kidney transplantation in patients with monoclonal gammopathy of renal significance

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.