Abstract: SA-PO1156
Treatment of C3 Glomerulopathy in Kidney Transplant Recipients: A Meta-Analysis
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Gonzalez Suarez, Maria Lourdes, University of Mississippi Medical Center, Jackson, Mississippi, United States
- Thongprayoon, Charat, Mayo Clinic, Rochester, Minnesota, United States
- Mao, Michael A., Mayo Clinic, Rochester, Minnesota, United States
- Cheungpasitporn, Wisit, University of Mississippi Medical Center, Jackson, Mississippi, United States
Background
C3 glomerulopathy (C3G), a rare glomerular disease mediated by alternative complement pathway dysregulation, is associated with a high rate of recurrence and graft loss after kidney transplantation (KTx). We aimed to assess the efficacy of different treatments for C3G recurrence after KTx.
Methods
Databases (MEDLINE, EMBASE, and Cochrane Database) were searched from inception through 05/03/2019. Studies that reported outcomes of adult KTx recipients with C3G were included. Effect estimates from individual studies were extracted and combined using random-effects. Protocol for this meta-analysis was registered with PROSPERO (no. CRD42019125718).
Results
Twelve studies (7 cohort studies and 5 case series) consisting of 122 KTx patients with C3G (73 C3GN and 49 DDD) were included. The pooled estimated rates of allograft loss among KTx patients with C3G were 33% (95%CI: 12%-57%) after eculizumab, 42% (95%CI: 2%-89%) after therapeutic plasma exchange (TPE), and 81% (95%CI: 50%-100%) after rituximab. Subgroup analysis based on type of C3G was performed. Pooled estimated rates of allograft loss in C3GN KTx patients were 22% (95%CI: 5%-46%) after eculizumab, 56% (95%CI: 6%-100%) after TPE, and 70% (95%CI: 24%-100%) after rituximab. Data on allograft loss in DDD KTx patients after different treatment modalities were limited (1 cohort and 1 case series, 4/6 (67%) after eculizumab, TPE (1 case series, 0/2 (0%) at 6 months) and rituximab (1 cohort, 3/3 (100%) allograft loss). Among 66 patients (38 C3GN, 28 DDD) who receive no treatment (likely due to stable allograft function at presentation and/or clinical judgment of physicians), pooled estimated rates of allograft loss were 32% (95%CI: 7%-64%) and 53% (95%CI: 28%-77%) for C3GN and DDD, respectively. Among treated C3G patients, data on sMAC were limited to patients treated with eculizumab. 80% patients with elevated sMAC before eculizumab responded to treatment. In addition, all patients who responded to eculizumab had normal sMAC level after post-eculizumab.
Conclusion
Our study suggests that KTX patients with C3G treated with eculizumab had the lowest incidence of allograft loss (33%) when compared to those treated with TPE or rituximab. Among those who received no treatment for C3G due to stable allograft function, there is an incidence of allograft loss of 33% in C3GN and 53% in DDD.