Kidney International Reports (Jan 2025)

Outcome of Patients Transplanted for C3 Glomerulopathy and Primary Immune Complex-Mediated Membranoproliferative Glomerulonephritis

  • Matthieu Halfon,
  • Patrick Taffé,
  • Christian Bucher,
  • Fadi Haidar,
  • Uyen Huynh-do,
  • Laila-Yasmin Mani,
  • Thomas Schachtner,
  • Caroline Wehmeier,
  • Jean-Pierre Venetz,
  • Manuel Pascual,
  • Fadi Fakhouri,
  • Dela Golshayan,
  • Patrizia Amico,
  • John-David Aubert,
  • Vanessa Banz,
  • Sonia Beckmann,
  • Guido Beldi,
  • Christoph Berger,
  • Ekaterine Berishvili,
  • Isabelle Binet,
  • Pierre-Yves Bochud,
  • Sanda Branca,
  • Heiner Bucher,
  • Emmanuelle Catana,
  • Yves Chalandon,
  • Sabina De Geest,
  • Sophie De Seigneux Michael Dickenmann,
  • Joëlle Lynn Dreifuss,
  • Michel Duchosal,
  • Thomas Fehr,
  • Sylvie Ferrari-Lacraz,
  • Christian Garzoni,
  • Christophe Gaudet,
  • Déla Golshayan,
  • Nicolas Goossens,
  • Jörg Halter,
  • Dominik Heim,
  • Christoph Hess,
  • Sven Hillinger,
  • Hans H. Hirsch,
  • Patricia Hirt,
  • Günther Hofbauer,
  • Uyen Huynh-Do,
  • Franz Immer,
  • Michael Koller,
  • Mirjam Laager,
  • Bettina Laesser,
  • Frédéric Lamoth,
  • Roger Lehmann,
  • Alexander Leichtle,
  • Oriol Manuel,
  • Hans-Peter Marti,
  • Michele Martinelli,
  • Valérie McLin,
  • Katell Mellac,
  • Aurelia Mercay,
  • Karin Mettler,
  • Nicolas J. Mueller,
  • Antonia Müller,
  • Ulrike Müller-Arndt,
  • Beat Müllhaupt,
  • Mirjam Nägeli,
  • Graziano Oldani,
  • Manuel Pascual,
  • Jakob Passweg,
  • Klara Posfay-Barbe,
  • Juliane Rick,
  • Anne Rosselet,
  • Simona Rossi,
  • Silvia Rothlin,
  • Frank Ruschitzka,
  • Thomas Schachtner,
  • Urs Schanz,
  • Stefan Schaub,
  • Simon Schwab,
  • Aurelia Schnyder,
  • Macé Schuurmans,
  • Thierry Sengstag,
  • Federico Simonetta,
  • Jürg Steiger,
  • Guido Stirniman,
  • Ueli Stürzinger,
  • Christian Van Delden,
  • Jean-Pierre Venetz,
  • Jean Villard,
  • Julien Vionnet,
  • Madeleine Wick,
  • Markus Wilhlem,
  • Patrick Yerly

DOI
https://doi.org/10.1016/j.ekir.2024.10.008
Journal volume & issue
Vol. 10, no. 1
pp. 75 – 86

Abstract

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Introduction: Approximately 50% of patients with C3 glomerulopathy (C3G) and primary immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) reach kidney failure 10 years after diagnosis. Because these patients are generally young, the majority will be listed for kidney transplantation (KTx). However, reported outcomes in patients transplanted for C3G and IC-MPGN are heterogeneous and conflicting, because they are mainly based on retrospective monocentric studies. We thus aimed to provide detailed multicenter data on these patients, taking advantage of the ongoing nationwide Swiss Transplant Cohort Study (STCS). Methods: We analyzed patient and graft outcomes, including the risk of graft loss in relation to recurrence of glomerulopathy. Results: Forty-one (10 C3G and 31 IC-MPGN) transplanted recipients were included with a mean age at transplantation of 48 ± 16 years. Living donors provided 53% of the organs. During a mean follow-up of 4.7 years, 7 patients (4 C3G and 3 IC-MPGN) presented disease recurrence with a mean time to recurrence of 1.2 years. New-onset or rapidly increasing proteinuria was an early marker of recurrence, preceding significant decline in estimated glomerular filtration rate (eGFR). Following recurrence, 28% lost their graft, compared to 11% of patients without recurrence. Disease recurrence was the primary cause of graft loss in all patients. Finally, 14% of patients died during follow-up. Conclusion: This study provides important insights into the epidemiology and outcome of patients with C3G and IC-MPGN and their grafts after KTx. The data also suggest that proteinuria may serve as an early biomarker of disease recurrence and should be considered in patient management as well as an endpoint in current clinical trials using novel complement modulators.

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