Although end-stage renal disease (ESRD) related to AA amyloidosis nephropathy secondary to tuberculosis is most common in our country, there are limited data concerning patient and graft outcome after renal transplantation (RTx). To the best of our knowledge, this is the first report of RTx in ESRD patient with secondary amyloidosis due to tuberculosis from India. A 30-year-old female with past history of pulmonary tuberculosis 3 years back was admitted with complaint of gradually progressive pedal oedema and nausea for 3 months. Renal biopsy was suggestive of secondary renal amyloidosis with vascular involvement and chronic tubulointerstitial involvement. She was transplanted with kidney from her 28-year-old brother with 3/6 human leukocyte antigen match. She had immediate good graft function without any perioperative complications (cardiovascular, infections, rejection and delayed graft function). She was discharged with serum creatinine of 0.8？mg/dL. Her last serum creatinine level was 0.9？mg/dL with cyclosporine level of 100？mg/dL at 9-month followup without any medical or surgical complication. The quality of life also improved after transplantation. With careful selection, ESRD patients with secondary amyloidosis due to tuberculosis are eligible for RTx with favorable outcome and improved quality of life. 1. Introduction The most frequent and life-threatening complication of secondary amyloidosis (AA) is renal disease characterized by nephrotic syndrome and a progressive decline of renal function leading to end-stage renal disease (ESRD). Kidney involvement constitutes a major prognostic factor in patients with secondary amyloidosis. Chronic inflammatory diseases (rheumatoid arthritis (RA)) and infections (tuberculosis (TB)) were the most common causes of renal amyloidosis in the developed countries and developing countries [1, 2]. Estimated frequency of AA amyloidosis in Western Europe is about 1/100,000. It comprises 2-3% of total amyloidosis. Overall incidence is about 0.5–1.3/100,000 annually. A total of 2401 renal biopsies were analyzed retrospectively from 1990 to 2008 in an Indian single centre, out of which 8% showed amyloidosis [3]. ESRD patients with AA amyloidosis are considered less suitable for renal transplantation (RTx) due to fear of cardiovascular, infectious complications, risk of graft loss from recurrent amyloid/progressive disease, and high risk of mortality [4]. Although ESRD related to AA amyloidosis nephropathy secondary to TB is most common in our country, there are limited data concerning patient and graft outcome after
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