Kidney Week

Abstract: FR-PO0854

C3 Glomerulopathy After Kidney Transplantation

Session Information

• Glomerular Outcomes: From Proteinuria to Prognosis
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Huang, Gaoyuan, Nephrology Department, University of Washington, Seattle, Washington, United States

Gaoyuan Huang, MD, MS

• Smith, Kelly D., Department of Pathology, University of Washington, Seattle, Washington, United States

Kelly D. Smith, MD, PhD

• Blosser, Christopher D., Nephrology Department, University of Washington, Seattle, Washington, United States

Christopher D. Blosser, MD

• Ng, Yue-Harn, Nephrology Department, University of Washington, Seattle, Washington, United States

Yue-Harn Ng, MD, MPH

• Jefferson, J. Ashley, Nephrology Department, University of Washington, Seattle, Washington, United States

J. Ashley Jefferson, MD, FASN

Background

We aim to assess the clinicopathological features influencing recurrence and outcome of adults with C3 glomerulopathy (C3G) after kidney transplant (KT).

Methods

All C3G patients who underwent KT at University of Washington from 2000 to 2024 were identified (n=15); 12 with complete data were analyzed.

Results

There were 10 C3 glomerulonephritis (C3GN) and 2 dense deposit disease (DDD) cases. Mean age at diagnosis was 31.2 (range 9-58 yrs), with 3 cases diagnosed before age 18 (1 DDD, 2 C3GN). Monoclonal gammopathy of uncertain significance (MGUS) was present in 4 C3GN cases, including 2 with recurrence. Of 11 tested, 7 showed complement abnormalities. CFH inhibitor in No.2R likely contributed to recurrence. All recurrent cases (n= 7) required dialysis before KT, with a median diagnosis-to-1^st KT time of 5 yrs (range 2-6 yrs). In non-recurrent cases (n=5), 2 were on dialysis, with a median diagnosis-to-1^st KT time of 15 yrs (range 6-36 yrs).
Post-KT recurrence rate was 58% (7/12, 5/10 C3GN and 2/2 DDD); 2/7 experienced graft loss due to recurrence. Median time from KT to histological recurrence was 5 months (range 9 d – 25 yrs). Among those who received prophylactic C5 inhibitors (n=7, all C3GN), 5/7 (70%) had recurrence with 1 progressing to ESRD. DDD recurred surprisingly late at 12 and 25 yrs post-KT and one of them progressed to ESRD. Evolving C3G pathology was observed in some cases.

Conclusion

Despite 58% recurrence, only 2/12 C3G cases developed ESRD after KT, endorsing KT eligibility. Patients with recurrent C3G were more frequently on dialysis prior to KT (100% vs. 40%) and had a shorter median diagnosis-to-1^st KT time (5 vs. 15 yrs), suggesting a more aggressive native disease course may be associated with recurrence. CFH inhibitor may drive C3G recurrence and graft failure. Prophylactic C5 inhibition did not appear to mitigate recurrence but may have slowed progression.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025wzy7eefr