Transplantation and 6-month follow-up of renal transplantation from a donor with systemic lupus erythematosus and lupus nephritis.
Transplantation of kidneys with pre-existing glomerulonephritis (GN) has rarely been reported. Little is known of the subsequent evolution of donor pathology in the recipient. We report a transplant using a donor with systemic lupus erythematosus (SLE) and a history of remote acute renal failure but normal renal function at death. Although the screening harvest biopsy was unremarkable, time zero post-implantation renal biopsy showed evidence of lupus nephritis (LN). Sequential protocol biopsies demonstrated gradual resolution of the donor pathology, and renal function was stable despite severe cardiac disease in the recipient. Studies examining the role of functional and biopsy data on outcomes in expanded criteria renal transplantation are reviewed, and the limits of guidance from use of this data are discussed. Pre-existing mild GN may not be an absolute donor exclusion for candidates willing to accept expanded criteria donors. Use of expanded pool kidneys should be guided by functional, biopsy and demographic information, as no single factor alone predicts outcome.
Schwartzman
Michael S
MS
Departments of Nephrology, Pathology and Transplant Surgery, Geisinger Medical Center, Danville, PA 17822, USA. msschwartzman@geisinger.edu
Zhang
Ping L
PL
Potdar
Santosh
S
Malek
Sayeed K
SK
Norfolk
Evan R
ER
Hartle
J Edward
JE
Weicker
Cristen A
CA
Yahya
Taher M
TM
Shaw
John H
JH
D058186:Acute Kidney Injury; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D008180:Lupus Erythematosus, Systemic; D008181:Lupus Nephritis / Q000209:etiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*