Clinical C3G recurrence occured in more than 50% after renal transplantation and is the first cause of allograft loss at 5 years post-transplantation. Eculizumab (EC) has been used in severe GC3 on native kidney and in few cases in graft recurrence with contreversal results. The aim of this study was to evaluate EC efficacy in graft GC3 recurrence in French cohort.

We retrospectively analyzed patients who received EC for a clinical GC3 graft recurrence. Clinical recurrence was defined by a proteinuria > 0.5 g/g and/or increasing serum creatinine > 30% from the baseline. Recurrence had to be proven by graft biopsy and was considered by C3 deposits without associated rejection. The efficiency of Ec was evaluated at 3 and 6 months. Partial remission (PR) was defined by stabilization (+/-25%) or improvement of serum creatinine and proteinuria reduction upper than 50%. Complete remission (CR) was defined by a normalized serum creatinin (basal value) and proteinuria lower than 0,5 g/g.

Ten patients received EC for C3G recurrence. Reccurence occured with a median of 56 days. At diagnosis serum creatinin median was 222,5 [mu]mol/L (range : 98-304 [mu]mol/L) and proteinuria was 1 g/g (range : 0,1-6,2 g/g). In all graft biopsies, C3 deposit was positive. At EC initiation median proteinuria was 1,75 g/g (range 0,58-3,97 g/g) and median serum creatinin was 214,5 [mu]mol/L (range 98-304 [mu]mol/L).

At 3 months, 2 patients had their treatment interrupted for ineffectiveness by clinicians and were considered non-responders. At 6 months, 7 patients had a EC-response (4 CR and 3 a PR) and 1 was non-responder. 2 of the three non-responders lost their graft. CR patients are all still under treatment and after a median follow-up of 62,7 months, have a stable renal function and proteinuria < 0,5 g/g suggesting lasting effectiveness.

All of CR under EC patients had at time of diagnosis an acute renal failure, massive proteinuria

Eculizumab is effective in 70% patients with C3G severe clinical recurrence, mostly in patient with acute renal failure and proteinuria. It's an option for clinical C3G recurrence treatment in subset of patients.

CITATION INFORMATION: Jeantet G, Bertrand D, Lionet A, Anglicheau D, Fremeaux-Bacchi V, Le Quintrec M. Eculizumab Treatment on GC3 Recurrence on Renal Graft. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress