Recurrent lupus nephritis after transplantation: Clinicopathological evaluation with protocol biopsies.
OBJECTIVE
Lupus nephritis (LN) is an important complication of systemic lupus erythematosus (SLE). The aim is to use indication and protocol biopsies to determine clinicopathological findings and outcomes of patients with LN undergoing kidney transplantation (KTx).


METHODS
Patients who underwent KTx due to LN were retrospectively analyzed. Recurrent LN (RLN) was diagnosed by transplant kidney biopsy.


RESULTS
Among 955 KTx patients, 12 patients with LN as the cause of end-stage renal disease were enrolled. Five patients were male. Mean follow-up time was 63 ± 34 months. At the last follow-up visit, mean levels of serum creatinine and proteinuria were 137.0 ± 69.0 µmol/L and 0.26 ± 0.26 g/day, respectively. Eighteen indication and 22 protocol biopsies were performed; 27 biopsies were additionally evaluated by immunofluorescence. In two recipients, subclinical RLN was confirmed by protocol biopsies. Clinical recurrence occurred in four patients. Among patients with RLN, time from diagnosis of LN to KTx was significantly shorter and use of ATG as induction treatment was significantly lower. Graft loss occurred in two recipients who had clinical RLN. Five-year overall graft survival was 85.7%.


CONCLUSIONS
Kidney transplantation is a reasonable option for patients with ESRD secondary to SLE. However, recurrence of LN is common if protocol biopsies are included in post-transplantation surveillance.
School of Medicine, Division of Nephrology, Ege University, Izmir, Turkey.
Aygül
http://orcid.org/0000-0003-4399-3746
A
Çeltİk
Ege University, School of Medicine, Department of Pathology, Izmir, Turkey.
Saİt
S
Şen
School of Medicine, Division of Nephrology, Ege University, Izmir, Turkey.
Abdülkerİm Furkan
AF
Tamer
School of Medicine, Division of Nephrology, Ege University, Izmir, Turkey.
Mümtaz
M
Yılmaz
Ege University, School of Medicine, Department of Pathology, Izmir, Turkey.
Banu
B
Sarsık
School of Medicine, Division of Nephrology, Ege University, Izmir, Turkey.
Mehmet
M
Özkahya
School of Medicine, Division of Nephrology, Ege University, Izmir, Turkey.
Alı
A
Başçı
School of Medicine, Division of Nephrology, Ege University, Izmir, Turkey.
Hüseyİn
H
Töz
D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008181:Lupus Nephritis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D007166:Immunosuppressive Agents; D003404:Creatinine
graft outcome; kidney transplantation; lupus nephritis; recurrence