Abstract: FR-PO768
Outcome of Renal Allograft with Preexisting Lupus Nephritis
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Xu, Zhengyuan, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Wang, Qihua, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Chen, Wenfang, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Yang, Shicong, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
Introduction
Preexsisting gomelular nephritis(GN) was not a contraindication for kidney donation. The outcome of renal allograft with pre-exsisting GN was not clearly demonstrated. Here, we presented a case of renal allograft with pre-exsisting proliferative lupus nephritis(LN).
Case Description
A 31-year-old female with diffuse sclerotic GN accepted deceased donor kidney transplantation(KT) at 2020. The 32-year-old female donor died of frontal lobe encephalorrhagia, with a medical history of systemic lupus erythematosus. At the time of death, the donor had proteinuria(urine ALB: 3.72g/L), increased serum creatinine（Scr）(180 umol/L), positive ANA(18.4U/ml ) and dsDNA(>300.00IU/ml). Pre-implantation histological examination of the kidneys showed "full-house" deposition in immunofluoroscence(IF), diffuse mesangial and endothlial proliferation with immune complex（IC）deposition under light microscope(LM), suggestive of RPS IV(A)+V，Remuzzi scoring=1. After KT, the recipient's Scr decreased while nephrotic range urine protein was notified. At 10th day post-KT, her Scr dropped to 100 umol/L and remained stable afterward, while her urine ALB was 4.34g/L and descended slowly. 3 months later, she undertook allograft renal biopsy with persistent proteinuria(urine ALB:111.5mg/L). The IC deposition persisted in glomerular base membrane with decreased intensity in IF, resembling membranous nephropathy(MN) in LM and electronic microscope. No hypercellularity or rejection was identified. Her urine protein turned negative 4 months after KT. Only slight transient ANA elevation was noted within the first 2 weeks (15-22 U/L), while dsDNA remained negative all throughout.
Discussion
Glomerular IC deposition is common in donor kidney biopsies, which would eventually “wash-out” over time. In our case, the allograft still presented with proteinuria and MN-like change 3 months after KT, indicating that IC clearance was slower than disappearance of hypercellularity. Hence allograft with pre-exsisting GN should undergo careful surveillance before radical clearance of IC to avoid possible complication caused by GN.