Outcome of Patients Transplanted for C3 Glomerulopathy and Primary Immune Complex-Mediated Membranoproliferative Glomerulonephritis
In a Swiss multicenter cohort of patients transplanted for C3 glomerulopathy (C3G) and immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN), disease recurrence was the primary driver of graft loss, with rising proteinuria serving as an early biomarker of recurrence.
Background
Roughly half of patients with C3G and primary IC-MPGN reach kidney failure within 10 years of diagnosis, and because these patients are generally young, most are listed for kidney transplantation. Reported post-transplant outcomes have been heterogeneous and conflicting, largely derived from small retrospective single-center studies.
Study design
The authors analyzed patient and graft outcomes within the prospective nationwide Swiss Transplant Cohort Study, including 41 transplant recipients (10 with C3G and 31 with IC-MPGN), with a mean age at transplantation of 48 years. Living donors provided 53% of the organs, and mean follow-up was 4.7 years. Outcomes assessed included graft loss in relation to disease recurrence.
Key findings
Seven of 41 patients (4 C3G and 3 IC-MPGN) experienced disease recurrence at a mean of 1.2 years after transplantation. Following recurrence, 28% lost their graft compared with 11% of patients without recurrence, and disease recurrence was the primary cause of graft loss in all cases. New-onset or rapidly increasing proteinuria emerged as an early marker of recurrence, preceding a significant decline in eGFR. Overall, 14% of patients died during follow-up.
Clinical implications
The data suggest proteinuria may serve as an early, actionable biomarker of disease recurrence and should be incorporated into post-transplant monitoring and used as an endpoint in trials of novel complement modulators. Findings reinforce the need for careful surveillance and emerging complement-targeted therapies to improve graft survival in this population.
Category
Transplant
Source
Kidney International Reports
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