Abstract: FR-PO1156
Successful Rescue of a Kidney Allograft from De Novo C3 Glomerulonephritis with Pegcetacoplan
Session Information
- Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Khan, Naseer, Medical City Healthcare, Dallas, Texas, United States
- Agha, Irfan, Medical City Healthcare, Dallas, Texas, United States
- Murad, Haris Farooq, Medical City Healthcare, Dallas, Texas, United States
- Roshan, Sara, Medical City Healthcare, Dallas, Texas, United States
- Ahmad, Hamza, Medical City Healthcare, Dallas, Texas, United States
Group or Team Name
- Dallas Renal Group at Medical City Transplant Dallas Texas
Introduction
C3 glomerulonephritis (C3GN) is a rare complement-mediated disease that frequently leads to graft loss when it recurs or presents de novo in renal allografts. Standard management with terminal complement blockade agents such as eculizumab often fail to halt the proximal complement dysregulation that drives persistent C3 deposition and glomerular injury. We report a case of de novo C3GN in an allograft successfully managed with targeted C3 inhibitor pegcetacoplan
Case Description
34-year-old female with a history of type 2 diabetes and end-stage renal disease (ESRD) received a living unrelated kidney transplant. Ten months post-transplantation, after initially excellent graft function, she presented with acute kidney injury with a creatinine of 3.3 mg/dL. A renal allograft biopsy performed on January 31 revealed severe glomerulitis with predominant C3 deposition, minimal no IgG or IgA or IgM deposits, confirming a diagnosis of de novo C3GN. The patient’s clinical course was complicated by uremia and severe fluid overload, necessitating the initiation of renal replacement therapy via hemodialysis.The patient was treated with pegcetacoplan, a recently FDA-approved proximal complement inhibitor.The patient exhibited a clinical response within two weeks of initiating pegcetacoplan leading to rapid and complete allograft recovery and the cessation of hemodialysis.
Discussion
De novo C3GN remains a therapeutic challenge because terminal pathway inhibition does not adequately address upstream complement dysregulation. This case demonstrates that proximal inhibition with pegcetacoplan can effectively interrupt alternative pathway activation, leading to rapid recovery and dialysis independence. To our knowledge, this is one of the first reports of successful de novo C3GN treatment using this approach
Immunoflorescnece showing C3 deposition