Frequency of recurrent lupus nephritis among ninety-seven renal transplant patients during the cyclosporine era

Arthritis Rheum. 1998 Apr;41(4):678-86. doi: 10.1002/1529-0131(199804)41:4<678::AID-ART15>3.0.CO;2-7.


Objective: To determine the frequency of recurrent lupus nephritis (LN) in patients with systemic lupus erythematosus (SLE) who underwent renal transplantation.

Methods: We reviewed the posttransplant clinical course and renal biopsy results in 97 consecutive SLE patients who underwent a total of 106 renal transplantation procedures at our center from January 1984 to September 1996.

Results: There were 81 female and 16 male patients, with a mean age of 35 years. Mean duration of dialysis prior to transplantation was 33.5 months; 9 patients were never dialyzed. In all patients, the disease was clinically and serologically quiescent at the time of transplantation. The mean posttransplantation followup period was 62.6 months. Patients underwent a total of 143 posttransplant biopsies. Nine patients had pathologic evidence of recurrent LN. Six of the patients with recurrence had cadaveric grafts, 2 had living-related grafts, and 1 had a living-unrelated graft. Recurrence occurred an average of 3.1 years after transplantation; the longest interval was 9.3 years and the shortest, 5 days. Histopathologic diagnoses on recurrence included diffuse proliferative glomerulonephritis, focal proliferative glomerulonephritis, membranous glomerulonephritis, and mesangial glomerulonephritis. In 4 patients, recurrent LN contributed to graft loss. Three of the patients with recurrence had serologic evidence of active lupus, but only 1 had symptoms of active lupus (arthritis). Three patients who lost their grafts secondary to recurrent LN underwent second renal transplantation procedures and had functioning grafts at 7, 30, and 35 months, respectively.

Conclusion: In the largest single medical center series of renal transplant patients with SLE, recurrent LN was more common than reported in the literature, but was not always associated with allograft loss. Recurrent LN was often present in the absence of clinical and serologic evidence of active SLE.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Analysis of Variance
  • Antibodies / blood
  • Antibodies, Antinuclear / analysis
  • Antibodies, Antinuclear / immunology
  • Antiphospholipid Syndrome / etiology
  • Biopsy
  • Cadaver
  • Cell Count
  • Cell Size
  • Cyclosporine / therapeutic use*
  • Female
  • Follow-Up Studies
  • Glomerular Mesangium / cytology
  • Glomerular Mesangium / pathology
  • Glomerular Mesangium / ultrastructure
  • Graft Rejection / pathology
  • Graft Rejection / physiopathology
  • Graft vs Host Disease / prevention & control
  • Histocompatibility Testing
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / pathology
  • Kidney Failure, Chronic / therapy
  • Kidney Glomerulus / pathology
  • Kidney Glomerulus / ultrastructure
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / pathology
  • Lupus Nephritis / etiology*
  • Lupus Nephritis / pathology
  • Lupus Nephritis / physiopathology
  • Male
  • Middle Aged
  • Recurrence
  • Renal Dialysis
  • Time Factors
  • Transplantation Conditioning


  • Antibodies
  • Antibodies, Antinuclear
  • Immunosuppressive Agents
  • Cyclosporine