Early Recurrence of C3 Glomerulopathy (C3G) in the Allograft

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Background: C3G encompasses both C3 glomerulonephritis (C3GN) and Dense Deposit Disease (DDD), a rare group of kidney diseases associated with alternative complement pathway dysregulation that commonly recurs in the allograft. How early recurrence occurs is underexplored. Methods: We reviewed cases of recurrent C3G in the allograft at CUIMC. Protocol biopsies were encouraged for transplanted C3G patients (PTS) at 6 months if a for-cause biopsy (bx) had not already been performed. Median (range) reported. Results: 13 PTS (9 C3GN, 4 DDD) were included (Table 1). 6 PTS (46%) had previous allografts fail due to C3G recurrence. Age at transplant was 32 years (18-71). Time from transplant to histologic recurrence was 54 days (5-472). 4 PTS (31%) had bland urine at first recurrence. 7 PTS (54%) had histologic recurrence at first allograft bx, 15 days (5-56) after transplant. After 2.3 years (0.33-10.1), 11 PTS (85%) remained with functioning allografts; 5 PTS (46%) had creatinine > 2 mg/dl. 2 DDD PTS had allograft failure. 6 PTS (43%) had acute T cell mediated rejection. 2 PTS received eculizumab-both were without clinical recurrence. Conclusions: This series highlights earlier histologic recurrence of C3G in the allograft than previously reported, partly due to protocol bx. Many PTS were without urinary abnormalities. At last follow up, majority of PTS had significant transplant CKD and 2 lost their allografts. Future study is needed to better understand if early detection of recurrence, coupled with anti-complement therapies, improves outcomes. Summary of Clinicopathologic Course After Histologic Recurrence

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