Successful transplantation of a donor kidney with diffuse proliferative lupus nephritis and crescents--a case report

Abstract

Pre-existing diffuse proliferative glomerulonephritis (DPGN) in a potential deceased kidney donor has been considered a contraindication for transplantation. We report a case of a patient who underwent a successful deceased donor renal transplantation from a donor with history of systemic lupus erythematosus (SLE) whose baseline biopsy revealed DPGN. Although the histology was relatively benign in the procurement kidney biopsy done by frozen section, the final light microscopy available after transplantation showed diffuse proliferative lupus nephritis, WHO class IV, with 44% crescents. The post-transplant course was complicated by delayed allograft function requiring haemodialysis for the first week. A repeat biopsy performed after 4 months of transplant showed resolution of the proliferative lesions in the glomeruli with disappearance of the crescents. At 5.5 years of follow-up, the patient's creatinine has been stable at 2.0 mg/dL (176.8 μmol/L), but he has persistent proteinuria.

Zero-Time Renal Transplant Biopsies

“…Finally, other histological lesions have been described in zero-time biopsies, like giant mitochondria 39 and donor glomerular pathology [40][41][42][43][44][45][46] . As these pre-existing conditions are very rare, guidance on the interpretation and implications of these findings only comes from individual case reports, and no general conclusions can be made.…”

Kidney Biopsy in Management of Lupus Nephritis: A Case-Based Narrative Review

“… 47 , 55 Few reports in the literature involving inadvertent transplantation of lupus kidneys to recipients without lupus showed that subendothelial immune complexes progressively decreased in intensity but were still detectable by light and immunofluorescence microscopy 6-8 months after kidney transplantation. 62 , 63 , 64 , 65 Subendothelial immune complexes disappeared from the kidney biopsies beyond 12 months. Interestingly, subepithelial deposits lasted much longer and were detectable by light microscopy and immunofluorescence microscopy even 3-5 years after transplantation.…”

“…Interestingly, subepithelial deposits lasted much longer and were detectable by light microscopy and immunofluorescence microscopy even 3-5 years after transplantation. 64 , 66 , 67 , 68 Electron microscopy may differentiate “new” from “old” subepithelial immune complex deposits in repeat kidney biopsies. New deposits are dense and found in the subepithelial space, while progressively older deposits migrate through the glomerular basement layers to the subendothelial space.…”