Kidney Week 2025 Early Program - Care of Kidney Transplant Candidates and Recipients-Early Recurrent Disease After Kidney Transplantation

Video Transcription

Video Summary

Dr. Gaurav Gupta (VCU) reviews rare but important causes of early recurrent kidney disease after transplantation that can be missed without vigilance. He highlights thrombotic microangiopathies (TMAs), especially complement-mediated TMA/atypical HUS, emphasizing the value of complement-gene testing pre‑transplant: many patients have identifiable mutations, recurrence is common, and graft loss can be high. For early post‑transplant TMA, he supports rapid treatment with C5 blockade (eculizumab) rather than waiting for lengthy workups, and notes recurrence can be renal-limited or late. He then discusses C3 glomerulopathy, defined by dominant C3 staining, with frequent early recurrence (often within 3 months); new complement inhibitors (factor B and C3 inhibitors) show promise for reducing proteinuria. He briefly covers ultra-rare catastrophic antiphospholipid syndrome and TTP (ADAMTS13 deficiency), where evidence is limited to case reports. For recurrent FSGS, risk is higher without genetic mutations; prophylactic plasmapheresis/rituximab lacks clear benefit, but treatment can induce remission in ~50%. Finally, he warns about primary hyperoxaluria type 2 recurring early and recommends screening patients with recurrent oxalate stones.

Asset Subtitle

Gaurav Gupta

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Speaker Gaurav Gupta

Keywords

Kidney transplant recurrent disease

Complement-mediated thrombotic microangiopathy (aHUS)

Eculizumab C5 blockade therapy

C3 glomerulopathy recurrence

Recurrent FSGS after transplantation