Kidney Transplants from a Donor with Systemic Lupus Erythematosus: A Clinical Case Report

Abstract

ABSTRACT

Background: Kidney transplantation (KT) remains the optimal therapy for patients with end-stage kidney disease (ESKD), offering improved survival and quality of life compared to dialysis. Due to the global shortage of organ donors, there is a growing trend toward expanding selection criteria, including acceptance of marginal or previously contraindicated donors. Lupus nephritis (LN) in deceased donors has traditionally raised concerns regarding transplant viability.

Case Presentation: We report the successful transplantation of both kidneys from a 34-year-old female donor with systemic lupus erythematosus (SLE) and biopsy-proven Class V lupus nephritis. Following brain death due to neuropsychiatric lupus, intraoperative biopsies confirmed minimal chronic damage. Recipient 1, a 51-year-old male with diabetes and hypertension, experienced delayed graft function (DGF), nosocomial pneumonia, and acute T cell–mediated rejection (Banff 1A). He responded to high-dose steroids, achieved partial renal function recovery, and was discharged without further dialysis. Recipient 2, a 39-year-old female with ESKD and a complex vascular access history, also experienced DGF but had progressive improvement in renal function post-discharge, with creatinine stabilizing at 1.4 mg/dL.

Conclusions: Limited data exist on transplantation outcomes from donors with active lupus nephritis. Prior case reports have shown variable outcomes, ranging from resolution of histological findings to allograft failure. These cases illustrate the potential utility of donor kidneys with pre-existing glomerulonephritis when carefully selected and monitored. Donor kidneys with lupus nephritis may be viable for transplantation under selected conditions. Enhanced donor screening protocols and recipient-specific risk stratification are essential to optimize outcomes and expand the donor pool.

KEYWORDS: Kidney transplantation, Lupus nephritis, Tissue donors