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Kidney Week

Abstract: PO1553

Early Recurrence of C3 Glomerulopathy (C3G) in the Allograft

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Peleg, Yonatan A., Columbia University Irving Medical Center, New York, New York, United States
  • Robbins-Juarez, Shelief, Columbia University Irving Medical Center, New York, New York, United States
  • Chang, Jae Hyung, Columbia University Irving Medical Center, New York, New York, United States
  • Crew, Russell J., Columbia University Irving Medical Center, New York, New York, United States
  • Cohen, David J., Columbia University Irving Medical Center, New York, New York, United States
  • Dube, Geoffrey K., Columbia University Irving Medical Center, New York, New York, United States
  • Husain, Syed Ali, Columbia University Irving Medical Center, New York, New York, United States
  • Mohan, Sumit, Columbia University Irving Medical Center, New York, New York, United States
  • Morris, Heather K., Columbia University Irving Medical Center, New York, New York, United States
  • Batal, Ibrahim, Columbia University Irving Medical Center, New York, New York, United States
  • Bomback, Andrew S., Columbia University Irving Medical Center, New York, New York, United States
Background

C3G encompasses both C3 glomerulonephritis (C3GN) and Dense Deposit Disease (DDD), a rare group of kidney diseases associated with alternative complement pathway dysregulation that commonly recurs in the allograft. How early recurrence occurs is underexplored.

Methods

We reviewed cases of recurrent C3G in the allograft at CUIMC. Protocol biopsies were encouraged for transplanted C3G patients (PTS) at 6 months if a for-cause biopsy (bx) had not already been performed. Median (range) reported.

Results

13 PTS (9 C3GN, 4 DDD) were included (Table 1). 6 PTS (46%) had previous allografts fail due to C3G recurrence. Age at transplant was 32 years (18-71). Time from transplant to histologic recurrence was 54 days (5-472). 4 PTS (31%) had bland urine at first recurrence. 7 PTS (54%) had histologic recurrence at first allograft bx,15 days (5-56) after transplant. After 2.3 years (0.33-10.1), 11 PTS (85%) remained with functioning allografts; 5 PTS (46%) had creatinine > 2 mg/dl. 2 DDD PTS had allograft failure. 6 PTS (43%) had acute T cell mediated rejection. 2 PTS received eculizumab- both were without clinical recurrence.

Conclusion

This series highlights earlier histologic recurrence of C3G in the allograft than previously reported, partly due to protocol bx. Many PTS were without urinary abnormalities. At last follow up, majority of PTS had significant transplant CKD and 2 lost their allografts. Future study is needed to better understand if early detection of recurrence, coupled with anti-complement therapies, improves outcomes.

Summary of Clinicopathologic Course After Histologic Recurrence
Patient IDTransplant TypeNative DiseaseDays to Histologic RecurrenceProtocol vs For CauseImmunosuppression at Histologic RecurrenceSerum Creatinine (SCR) at Biopsy (mg/dl)LM Findings at First RecurrenceMost Severe LM Findings on Follow UpMost Severe Rejection on Follow UpAllograft outcomeEculizumab at last follow upFollow Up Time OR Time to Allograft Failure (Years)
1DDKTDDD24For CauseTacrolimus, IVIG, Myfortic2.0Mild Mesangial ProliferativeMild Mesangial Proliferative1A ACRSCR 2.2, No hematuria, No proteinuriaYes4.2
2LDKTC3GN12For CauseTacrolimus, Myfortic, Prednisone, Eculizumab4.7Mild Mesangial ProliferativeMild Mesangial Proliferative1B ACRSCR 1.1, No hematuria, No proteinuriaYes3.4
3LDKTC3GN5ProtocolPLEX, Rituximab, IVIG (DSA+), Tacrolimus, Myfortic, Prednisone4.3Mild Mesangial ProliferativeDiffuse Mesangial Proliferative with Mild Endocapillary Hypercellularity1B ACRSCR 2.9, Hematuria, ProteinuriaNo3.2
4LDKTDDD472ProtocolTacrolimus, Myfortic1.5LM negative, IF/EM+LM negative, IF/EM+NoneSCR 1.4, No hematuria, No proteinuriaNo4
5DDKTC3GN466For CauseTacrolimus, Myfortic3.2Mild Mesangial ProliferativeMild Mesangial and Membranoproliferative, Severe SclerosingNoneSCR 3.6, No hematuria, proteinuriaNo9.7
6LDKTC3GN84ProtocolTacrolimus, MMF, Prednisone1.5LM negative, IF/EM+Mild Mesangial ProliferativeNoneSCR 1.5 No hematuria No proteinuriaNo2.1
7LRKTDDD356ProtocolTacrolimus, MMF1.9Diffuse Mesangial Proliferative & SclerosingMesangial and membranoproliferative proliferative, endocapillary proliferative, cellular crescents, severe sclerosing2A ACRFailed allograft, re-transplantedNo10.1
8DDKTC3GN54For CauseBelatacept, MMF1.9LM negative, IF/EM+LM negative, IF/EM+Chronic Active T Cell Mediated Rejection (borderline)SCR 1.8, No hematuria, No proteinuriaNo2
9DDKTC3GN21For CauseTacrolimus, MMF4.0LM negative, IF/EM+Mild Mesangial ProliferativeNoneSCR 1.5, No hematuria, No proteinuriaNo2.3
10LDKTC3GN8For CauseTacrolimus, MMF2.2LM negative, IF/EM+LM negative, IF/EM+NoneSCR 2.1No1.1
11LDKTC3GN120ProtocolN/A2.0LM negative, IF/EM+Mild Mesangial ProliferativeChronic Active T Cell Mediated Rejection (2A)SCR 2.1No1
12DDKTDDD56For CauseTacrolimus, Myfortic2.1LM negative, IF/EM+Focal Necrotizing and Crescentic GNNoneFailed Allograft, on HDNo0.33
13LDKTC3GN15For CauseTacrolimus, Myfortic1.6LM negative, IF+Mild Mesangial ProliferativeNoneSCR 1.5, Hematuria, ProteinuriaNo1