Use of Anti-interleukin-1 Agents in Kidney Transplant Recipients with Familial Mediterranean Fever and Amyloidosis: What have been learned so far?

Purpose of review: Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease causing amyloidosis (AA type) which may result in development of end-stage kidney disease (ESKD). Colchicine is the initial treatment option for patients FMF/amyloidosis both before and after KT. Although, kidney transplantation (KT) can be offered to patients with ESKD due to FMF/amyloidosis, FMF attacks did not resolve in some of kidney transplant recipients (KTRs) and de-novo development of amyloidosis after KT may be observed despite colchicine treatment. For these patients, other treatment options are warranted including anti-interleukin-1 agents such as anakinra and canakinumab. The purpose of the review is to summarize the use of anti-interleukin-1 agents in KTRs with FMF and amyloidosis.

Recent findings: Recent studies showed that these agents are effective in KTRs in terminating FMF attacks and decreasing inflammatory parameters. Furthermore, no significant interaction with immunosuppressive drugs were recorded and side effects were few. However, there are various knowledge gaps.