Impact of Kidney Transplantation on Hospitalization Outcomes in Patients with Multiple Myeloma

Introduction:

Despite the advancement in the treatment of Multiple Myeloma, most of the patients still develop end-stage renal disease, requiring hemodialysis. Kidney transplant is rarely performed due to risks of graft rejection and other complications, and data is limited to only a few case reports.

Objective:

In this study, we aimed to determine the impact of kidney transplants' impact on all-cause mortality and other outcomes in multiple myeloma patients who were hospitalized.

Methods:

We conducted a retrospective analysis using the National Inpatient Sample Database (NIS) from 2016 to 2020. We used ICD-10 codes to diagnose patients with a primary diagnosis of Multiple Myeloma (MM). The database was further used to classify the MM patients who underwent kidney transplants due to irreversible kidney damage. We calculated the multivariate regression analysis after adjusting for confounding variables.

Results:

A total of 580,544 patients were detected with a primary diagnosis of multiple myeloma between 2016 and 2020. Out of them, 1741 patients had a history of kidney transplant. The mean age of the patients was 64 years (P-value <0.001). Out of them, 62% (n=359,937) of the patients were male, while 38% (n=220,606) of them were female (p-value 0.03). The majority of the patients who underwent kidney transplants were white (62%, n=1079), while the black population constituted 23% (n=400), and Hispanics were almost 7% (n=122) of the patients. Most patients (78%) had medicare insurance, 18% had private insurance, and 3% had Medicaid (p-value 0.2). Our analysis showed that multiple myeloma patients who underwent kidney transplants had a decrease in mortality (aOR 0.9, p-value 0.09). However, it revealed that kidney transplant was associated with an increased risk of organ rejection (2%, aOR 49 [95% CI: 10- 235], p-value <0.01), organ infection (0.2%, aOR 11 [95% CI: 1.5-84], p-value 0.01), organ failure (4%, aOR 23 [95% CI: 6-82], p-value <0.001) and sepsis (11.6%, AOR 1.2 [95% CI: 0.6-2.3], p-value 0.5).

Conclusion:

Our study concludes that for renal damage caused by multiple myeloma, kidney transplants if performed, are associated with a decrease in all-cause mortality. However, it is also found to be associated with an increase in worse outcomes, including organ infection, rejection, and failure. Hence, although it has mortality benefits, kidney transplant comes with substantial risks leading to rejection and wasting of the organ. More research is needed to understand these associations better and improve patient selection for possible transplants.