C3 glomerulopathy post kidney transplantation: A single center experience

Area of Science:

• Nephrology
• Transplantation Immunology
• Complement System Biology

Background:

• C3 glomerulopathies (C3G) are rare kidney diseases caused by complement system dysregulation.
• Kidney transplantation in C3G patients is associated with high recurrence rates and poor graft survival.
• The efficacy of eculizumab, a terminal complement inhibitor, for C3G post-transplant is not well-established.

Purpose of the Study:

• To evaluate kidney transplant outcomes in patients with C3G.
• To assess the impact of eculizumab treatment on graft survival in C3G kidney transplant recipients.

Main Methods:

• Retrospective study of kidney transplant recipients with biopsy-confirmed C3G (1993-2023).
• Analysis of allograft function, recurrence, graft failure, and treatment with eculizumab.
• Re-evaluation of biopsy findings by a renal pathologist.

Main Results:

• Fifteen patients were included; 14 had recurrent C3G, 1 had de novo C3G.
• Median graft survival was 48 months; recurrence occurred at a median of 7 months.
• Patients treated with eculizumab had a median graft survival of 73 months (5/7 functioning grafts), versus 22 months for untreated patients (0/7 functioning grafts, P=0.003).

Conclusions:

• C3G recurrence post-kidney transplant is common and leads to poor prognosis without treatment.
• Untreated C3G recurrence results in a median allograft survival of less than 2 years.
• Early eculizumab treatment may enhance transplant outcomes in recurrent C3G.