Free light chain and intact immunoglobulin abnormalities in heart transplant recipients: Two year follow-up timelines and clinical correlations

• Published in: Transplant immunology 2017-03, Vol.41, p.22-26
• Main Authors: Sečník, Peter, Lavríková, Petra, Hošková, Lenka, Malíková, Pavlína, Jabor, Antonín, Franeková, Janka
• Format: Article
• Language: English
• Subjects: Adult; Aged; Allergy and Immunology; Electrophoresis; Female; Follow-Up Studies; Free light chains; Heart Transplantation; Humans; Immunofixation; Immunoglobulin kappa-Chains - blood; Immunoglobulin lambda-Chains - blood; Male; Middle Aged; Posttransplant lymphoproliferation
• ISSN: 0966-3274; 1878-5492
• DOI: 10.1016/j.trim.2017.01.003

Abstract Objectives To assess the timelines of serum free light chain (sFLC) concentrations and the kappa/lambda light chain (K/L) ratio in heart transplant (HTX) recipients. To analyze the performance of serum protein electrophoresis (SPE), serum immunofixation (sIFE) and sFLC measurements for gammopathy detection following a HTX. Methods A total of 96 patients who underwent a HTX were analyzed during a two-year follow-up period. The relevant clinical data were obtained from patient medical records. SPE, sIFE and sFLC methods were used for the detection of free light chain and intact immunoglobulin gammopathies at 4 time points after HTX. Results A statistically significant decrease in sFLC K and L (a decrease of 39.1 % and 27.6 %, respectively, when compared to pretransplant values) was found 9 months after the HTX ( p < 0.001, Friedman test). We detected SPE or sIFE abnormalities in 23 (8.4 %) samples, and sFLC K/L ratio abnormalities in 34 (12.4 %) samples. All of the K/L ratio abnormalities had normal SPE/sIFE values, and 19 % of the findings were persistent. Conclusions A significant and consistent dynamics in the sFLC concentration was found in the HTX patients during a 2-year follow-up period, which reflected changes in the immunosuppressant dosage. A remarkable number of monoclonal and polyclonal gammopathies was identified with some persistent abnormalities, using the SPE/sIFE and sFLC methods. Some of the detected abnormalities, which might possess a higher risk for PTLD if interpreted according to common practice in nonTX patients can only be detected by sFLC methods.