Abstract: FR-PO0801
Pegcetacoplan for Prophylaxis Against C3 Glomerulopathy Recurrence After a Second Kidney Transplantation in a High-Risk Patient
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Borovitz, Yael, Schneider Children's Medical Center of Israel, Petah Tikva, Center District, Israel
- Rahamimov, Ruth, Rabin Medical Center, Petah Tikva, Center District, Israel
Introduction
C3 glomerulopathy (C3G) is a rare complement-mediated disorder caused by dysregulation of the alternative pathway. Disease recurrence after kidney transplantation is common and may lead to graft failure. A second transplantation in such patients is challenging and controversial. We report a case of successful second kidney transplantation in a high-risk patient treated prophylactically with pegcetacoplan.
Case Description
A 38 year old man was diagnosed with C3G at age 15 years. Despite immunosuppressive therapy, he progressed to end-stage kidney disease and underwent a living non related kidney transplantation at age 32 years. Complement workup before transplantation revealed high titers of anti-factor H antibodies, positive C3 and C5 nephritic factors, and elevated C5b-9 levels. Genetic analysis was negative.
Two months after transplantation, disease recurrence was diagnosed and eculizumab treatment was initiated, resulting in normalization of proteinuria and kidney function. Remission lasted 24 months; however, nephrotic-range proteinuria subsequently developed, accompanied by rapid graft deterioration.
Treatment with oral iptacopan was initiated without improvement, and severe prolonged diarrhea developed. After 6 months serum creatinine had already increased to 3.5 mg/dL a trial of Pegcetacoplan was initiated; however, no improvement was achieved and hemodialysis was started.
Repeat complement workup during disease recurrence demonstrated similar findings - a high titer of anti-factor H antibodies, positive C3 nephritic factor, positive C5 nephritic factor and elevated C5b-9 levels.
At age 37 years, the patient received a second living related kidney transplantation from his brother. Given the high risk of recurrence, prophylactic treatment with pegcetacoplan was initiated in addition to standard immunosuppressive therapy. Six months post-transplantation, the patient remains free of complications, with stable renal function, no proteinuria or hematuria, and ongoing pegcetacoplan prophylaxis.
Discussion
This case highlights the potential feasibility of a second kidney transplantation after graft loss due to recurrent C3G. Treatment with proximal complement inhibitors may prevent C3G recurrence. Longer follow-up and further studies are needed to establish the safety and efficacy of this therapeutic approach.