Systemic lupus erythematosus is a chronic autoimmune disease of unknown etiology and variable course. It affects a number of organ systems, often the kidneys. Lupus nephritis occurs in half of lupus patients and often leads to chronic kidney disease and kidney failure. Patients who reach the final stage of chronic kidney disease need renal replacement therapy and the method of choice in lupus nephritis is kidney transplantation. Historically, kidney transplantation has been avoided in patients with lupus nephritis due to the view that the outcomes of transplantation are worse than in patients suffering from other diseases and that recurrence of the disease in the graft is common. The recommendations were that patients first receive dialysis and wait a certain time before the transplant procedure in order to let the disease activity slow down and thus improve the outcome. However, today's research has shown that the pre-transplantation time spent on dialysis affects post-transplantation outcomes negatively and that any lupus nephritis patient with an indication for transplantation should receive a transplant as soon as possible, preferably a preemptive transplant, which has by far the best outcomes. Studies have also shown that transplant outcomes in patients with lupus nephritis can be compared with other patients and that there are no significant differences. Recurrent lupus does not appear to be as common as previously thought, and when it does occur, most cases are subclinical and do not require additional immunosuppression.