Complement-mediated renal diseases after kidney transplantation - current diagnostic and therapeutic options in de novo and recurrent diseases

Table 7 Transplant considerations in C3 glomerulopathy¹

Timing	Donor selection	Risk reduction
Avoid transplantation during acute period of renal loss	No specific recommendation can be made on donor choice. When considering living donors, high risk of recurrence should be weighed against presumed risk of waiting on cadaveric donor list	C3G histological recurrence is as high as 90%[7,87]
Avoid transplantation during acute inflammation		Limited data suggest: rapid progression to ESRD in native kidneys increases recurrence risk[87]
No data supporting whether specific complement abnormalities (e.g., high titer C3Nef, low C3 or high soluble C5b-9) predict increased risk for relapse		There are no known strategies to reduce recurrence risk of C3G
		Clinical recurrence should drive decision to treat[7]
		In absence of clinical trials, use of anti-complement therapy is based solely on a small open-label trial and positive case reports[62] (the impact of publication bias is unknown)
		C3G associated with monoclonal gammopathy has a high rate of recurrence[7]

¹Based on limited retrospective cohort data. Adapted from Goodship et al[12]. C3: Complement component 3; C3G: C3 glomerulopathy; C3Nef: C3 nephritic factor; ESRD: End-stage renal disease.