Deep immunological resetting in refractory systemic lupus erythematosus post-kidney transplantation: A longitudinal immunophenotypic analysis

Abstract

Background

A 66-year-old female with a 15-year history of refractory lupus nephritis, complicated by severe hypersplenism requiring splenectomy and 8 years of hemodialysis, successfully underwent deceased-donor kidney transplantation. Post-transplantation, she achieved an unprecedented, durable serological remission with a distinctive biphasic platelet recovery.

Methods

To monitor her immune reconstitution, we performed longitudinal peripheral blood immunophenotyping, contextualized against an active systemic lupus erythematosus (SLE) cohort and an age-matched healthy control group to account for immunosenescence.

Results

Notably, the B-cell repertoire maintained a persistently stable, low-end baseline of marginal zone B cells within the age-appropriate spectrum, reflecting the static legacy of her prior splenectomy. In sharp contrast to this static background, the T-cell compartment demonstrated a dynamic, within-subject V-shaped recovery of killer cell lectin-like receptor G1 + effector memory cytotoxic T cells (KLRG1 + EM Tc cells) from an active-disease baseline to age-appropriate healthy levels.

Conclusions

This case illustrates that KLRG1 + effector memory cytotoxic T cell recovery is a signature of genuine immunological remission rather than mere aging or historical confounders, suggesting its potential as a precision biomarker for monitoring post-transplant immune stability in SLE.