Systemic lupus erythematosus after renal transplantation: is complement a good marker for graft survival?

Transplant Proc. 2008 Apr;40(3):746-8. doi: 10.1016/j.transproceed.2008.02.045.


Background: Renal transplantation is considered a safe procedure for patients with systemic lupus erythematosus (SLE). However, the recurrence of disease and its impact on graft survival remains controversial.

Methods: To analyze the presence of lupus serology activity during dialysis and its impact on lupus recurrence after transplantation, we performed a retrospective analysis of 23 lupus patients who received 26 kidney transplantations.

Results: Twenty-three patients received 26 renal transplantations from 1984 to 2003. Twelve patients presented pretransplant lupus activity (low complement and ANA > 1/40), without correlation with length of dialysis, but associated with proliferative glomerulonephritis (class IV) pretransplant. Among 26 grafts, 6 were lost in the first 6 months posttransplant. Among the remaining 20 functioning grafts, low complement activity occurred in 8, being associated with recurrence of immune deposits in 3 cases. Analysis of lupus activity showed that only one patient with a normal complement level posttransplant presented SLEDAI > 4, associated with persistent proteinuria and a graft biopsy without immune deposits. Graft survival was reduced in the presence of low complement posttransplantation.

Conclusion: Low complement levels after renal transplantation, in association with proteinuria may be considered to be a risk factor for recurrence of immune deposits, with a negative impact on graft survival.

MeSH terms

  • Biomarkers / blood
  • Complement System Proteins / metabolism*
  • Graft Survival / physiology*
  • Humans
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / physiology*
  • Lupus Erythematosus, Systemic / epidemiology*
  • Postoperative Complications / epidemiology*
  • Recurrence
  • Time Factors


  • Biomarkers
  • Complement System Proteins