Would you proceed with renal transplant in a patient with lupus nephritis who has progressed to ESRD and is clinically stable, but has persistently elevated dsDNA and low complements despite appropriate doses of hydroxychloroquine and mycophenolate?

Short answer: Yes—if the patient’s clinical lupus is quiescent for at least 6 months, it is reasonable to proceed with kidney transplantation even in the presence of persistent serologic activity (e.g., low complement, elevated anti-dsDNA).

Why this matters:

• Transplant > Dialysis: Patients with LN-ES...

I would consider labs to be a helpful guide; however, the decision to inc/fail immunosuppressant and get a transplant of a kidney is a major decision. Given the patient is ESRD, they have chronic inflammation. I would be doing UA, urine protein/creatinine to look for activity of the disease in that ...

I agree with Dr. @Dr. First Last's comments that getting patients transplanted as soon as possible enhances QoL and survival, and that elevated adsDNA or low C4 (due to the presence of possible null alleles) does not necessarily imply active nephritis.

The referenced Toronto cohort study reported th...

I think it really depends on the quiescence of the lupus. As long as they are on <10 mg prednisone, with no clinical evidence of activity, we will transplant. They can also be on belimumab; the key is clinical quiescence.