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Abstract: FR-PO770

Late-Onset Recurrent Lupus Nephritis (rLN) in a Kidney Transplant Recipient

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Shenoy, Prashamsa, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States
  • Hajnoczky, Nora, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Yadav, Anju, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States
  • Gulati, Rakesh, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States

Despite advances in early allograft survival, long-term graft survival has continued to be a challenge. Recurrence of glomerular disease along with acute/ chronic rejection is the most common cause of allograft failure. We present a treatable case of graft failure 27 years post-transplant.

Case Description

A 53-year-old Latino male with history of Class IV Lupus nephritis (LN) 27 years post living related kidney transplantation, maintained on azathioprine and prednisone with good medical adherence presented for a follow-up. He was noted to have a rise in creatinine of 1.51mg/dL (baseline of 1.1-1.3mg/dL) and a urine protein creatinine ratio of 500mg/g. Work-up was significant for suppressed complements, an elevated Anti-DS DNA (16IU/ml), with positive Anti-cardiolipin and Anti-B2 Glycoprotein antibodies. Renal allograft biopsy showed 1/14 glomeruli sclerosed and 2 glomeruli showing endocapillary hypercellularity with hyaline deposits and vascular intimal thickening. There was an old chronic anti-allograft lesion and C4D staining of peritubular capillaries, which is deceivingly noted in LN. There was full house immunofluorescence staining of the glomerular capillary walls and mesangium in 5 glomeruli. Electron microscopy revealed prominent electron-dense deposits in the subendothelium, mesangium, peritubular capillaries and basement membranes. Overall suggestive of rLN Class IV with mild activity and chronicity. The patient was switched to Mycophenolic acid and prednisone 10 mg daily which resulted in complete remission in the next six months that persists three years post-biopsy.


rLN is common cause of transplant failure describing upto 93% incidence of graft failure and 43% allograft rejections in the first 10 years of transplant. We demonstrate rLN 27 years post-transplant. Although rLN is reported upto 15 years, it is uncommon, underdiagnosed and adds a potentially treatable cause of graft failure to the evergrowing kidney waitlist. Also, our patient is a perfect outlier for traditional risk factors for rLN such as African ancestry, female gender, age 30-40 yrs, pre-transplant dialysis, and receiving a deceased donor transplant. Therefore, this report conveys the importance of keeping high suspicion for prompt diagnosis and management of rLN to improve the long-term survival of the allograft.