Kidney Week

Abstract: FR-PO1158

Pre- and Post-Transplant Pegcetacoplan: A Novel Approach to Preventing C3 Glomerulopathy Recurrence

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

• Parulekar, Jaya S., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Jaya S. Parulekar, MD

• Ghossein, Cybele, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Cybele Ghossein, MD

• Agrawal, Akansha, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Akansha Agrawal, MD

• Al-Ani, Awsse, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Awsse Al-Ani, MD, MBBS

Introduction

C3 glomerulopathy (C3G) is a rare kidney disease characterized by dysregulation of the alternative complement pathway, leading to membranoproliferative glomerulonephritis. Patients with C3G can have a rapidly progressive course, with kidney transplantation often hindered by a high rate of recurrence. Traditional therapies have limited efficacy in the treatment of C3G. Pegcetacoplan (PEG), a novel C3/C3b inhibitor, has shown promising results in native and transplanted kidneys. We present the case of a patient with a history of recurrent transplant C3G treated with PEG preemptively prior to her second kidney transplant.

Case Description

A 28-year-old woman who presented with C3G at age 13 underwent living related kidney transplant at age 21. This was complicated by recurrence of C3G within 1-month post-transplant (Figure 1), requiring a return to dialysis. In preparation for her second living donor kidney transplant at age 28, PEG was initiated 1 month prior to surgery and continued post-transplant. Complement, urine, and blood testing post-first transplant and pre-and post-second transplant are shown in Table 1. She is currently 2 months post-transplant and has had no evidence of C3G recurrence on lab monitoring.

Discussion

Preemptive pre-transplant PEG represents a novel approach to prevent C3G recurrence and preserve allograft function. This case demonstrates a paradigm shift from reactive treatment of C3G to proactive prevention. By addressing the underlying pathophysiology of complement inhibition before allograft injury occurs, this treatment strategy offers significant promise for high-risk transplant candidates with C3G.

Acknowledgment

Complement testing and analysis from the Molecular Otolaryngology and Renal Research Laboratories at the University of Iowa are gratefully acknowledged.