Recurrent multiple myeloma following renal transplantation: a case report.

Renal transplantation is generally not considered for patients with multiple myeloma (MM) because of their extremely poor prognosis. However, for patients in remission, it offers an alternative to dialysis. There are few reports of MM recurrence among kidney transplant recipients. We report a 57-year-old white man with end-stage renal disease (ESRD) and known multiple myeloma in remission who underwent kidney transplantation. Eighteen months after transplantation upon routine follow-up, he was observed to have an elevated creatinine with no evidence of recurrence of myeloma upon bone marrow aspiration. Light microscopy and immunofluorescence of a renal biopsy showed chronic scarring of the kidney owing to cast nephropathy consistent with MM recurrence. Repeat bone marrow aspiration 1 week later confirmed this diagnosis. A review of the literature of prior studies suggested that it is reasonable to perform renal transplantation in patients with ESRD due to MM in remission, but large prospective studies would help to develop a strategy for prevention of multiple myeloma recurrence.

Rat liver tryptophan pyrrolase activity and gene expression during alcohol withdrawal.

Rat liver tryptophan (Trp) pyrrolase activity and gene expression were studied in relation to the alcohol-withdrawal syndrome (AWS). Both activity and gene expression were enhanced after withdrawal of ethanol-containing liquid diets and the time-course of these changes mirrored that of development and intensity of the behavioural disturbances of the AWS. By contrast, no correlation was observed between the AWS-induced behaviour and changes in activity of another hepatic glucocorticoid-inducible enzyme, tyrosine aminotransferase, and a negative correlation was noted between behaviour and the gene expression of this latter enzyme and also of that of the hepatic glucocorticoid receptor. We suggest that the metabolic consequences of activation of liver Trp pyrrolase during alcohol withdrawal may play a role in the behavioural features of the AWS.