Transplantation and 2-year follow-up of kidneys procured from a cadaver donor with a history of lupus nephritis

Background. Two patients underwent cadaver transplantation with kidneys fro m a donor with a history of World Health Organization Class IV/V lupus neph ritis, and we report their clinical and pathological outcome. Methods. The donor had a diagnosis of lupus nephritis made by renal biopsy 5 years before donation. At the time of donation, a biopsy was performed on the donor and on one of the recipients at 2 months and 1 year after the tr ansplant. Results. Both recipients underwent uneventful renal transplantation. On the first postoperative day, the donor's final pathological results became ava ilable. Although the frozen section seemed to be quite benign, the permanen t sections revealed World Health Organization Class II/V lupus nephritis, w ith full house immunofluorescence and multiple electron dense deposits. Bio psies were performed on recipient #2 at 8 weeks and 1 year after the transp lant, These revealed marked diminution followed by complete resolution of a ll tubular reticular structures and deposits as well as immunofluorescent a ctivity. Both recipients remain with normal renal function and urinalysis a t 3 years after the transplant. Conclusion. Although a history of clinically significant renal disease has been considered an absolute contraindication to kidney donation, with appro priate workup and caution, select patients may still be considered, which w ould increase the potential donor pool.