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  • A Case Report of Recurrent ...
    Romero Karam, Lily A.; Patel, Amol M.; Truong, Luan; Gonzalez, Juan M.

    Transplantation proceedings, March 2020, 2020-Mar, 2020-03-00, 20200301, Letnik: 52, Številka: 2
    Journal Article

    Renal transplantation is an ever-growing therapeutic option for patients with end-stage renal disease due to lupus nephritis. Outcomes for these patients are comparable to those of patients receiving renal transplantation for other causes. A known complication for these patients is recurrence of lupus nephritis in the renal graft (recurrent lupus nephritis RLN). Although disease severity at the time of recurrence is usually milder, a small number of cases have been reported to progress to allograft failure. There is a trend toward preemptive renal transplantation in patients with lupus nephritis, as more favorable outcomes have been observed with this treatment modality. While clinicians usually seek clinical remission of lupus prior to proceeding with renal transplantation, no guidelines are established regarding how often to check for serologic activity of lupus in patients with end-stage renal disease due to lupus nephritis and whether these serologic markers should be taken into account when deciding on the timing of transplantation. We present a case of early RLN co-occurring with acute cellular rejection 15 days after renal transplantation. The patient had been in clinical remission for more than 5 months prior to transplantation but had a rise in anti–double-stranded DNA antibody titers and a decrease in complement C3 level at the time of surgery. Although additional studies are needed to establish the extent to which serologic markers of lupus correlate with renal graft dysfunction, this case suggests hypocomplementemia and high double-stranded DNA antibody titers may be a risk factor for early RLN. •Recurrent lupus nephritis may contribute to allograft loss in a small number of patients.•Scant data exist on the role of complement levels and double-stranded DNA titers in patients with end-stage renal disease who do not have clinically active lupus. Whether serologic markers should be taken into account when deciding on the optimal timing of renal transplantation in patients with end-stage renal disease due to lupus nephritis remains uncertain.•This case highlights a rise in double-stranded DNA titers and a decrease in complement C3 levels before renal transplantation in a patient with recurrence of lupus nephritis on post-transplantation day 15, suggesting there may be a correlation between serologic lupus activity and early recurrence of lupus nephritis.