Complement therapy in transplant patients in C3G

EP: 1.An overview of IgA Nephropathy

EP: 2.IgA Nephropathy in Different Ethnic Populations

EP: 3.IgA Nephropathy in the Transplant Population

EP: 4.IgA Nephropathy in Pediatric Patients

EP: 5.An Overview of C3G

EP: 6.C3G in Pediatric Patients

EP: 7.Challenges of Managing C3G

EP: 8.Consequences of a Late or Missed Diagnosis of C3G

EP: 9.Differential Diagnosis of C3G

EP: 10.The Pathology of IgAN on Kidney Biopsy

EP: 11.The role of electro microscopy in the diagnosis of IgAN

EP: 12.Kidney biopsy as a guide for treatment and prognosis

EP: 13.Diagnostic testing in C3G

EP: 14.Diagnosing C3G in pediatric patients

EP: 15.Kidney biopsy C3G

EP: 16.Building expertise in C3G

EP: 17.Clues to C3G in a biopsy

EP: 18.Barriers to kidney biopsy

EP: 19.Current standard of care for C3G

EP: 20.Clinical trial data on complement inhibition in C3G

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EP: 21.Complement therapy in transplant patients in C3G

EP: 22.Clinical trial data on IgAN for therapies

Jonathan Barratt, PhD, FRCP: Anuja, you touched on something interesting in your context of post-transplant recurrent disease. Is transplant patients have a lot of immunosuppression on board. And it doesn't seem to impact greatly on recurrence of IgA, but also C3G in your, is that your experience?

Anuja Java, MD: That is correct.

Jonathan Barratt, PhD, FRCP: And that shows a limitation really of conventional approaches.

Anuja Java, MD: That is right.

Jonathan Barratt, PhD, FRCP: Would you, in terms of your transplant practice, where would you see complement, therapies fitting in, in the context of patients already on often triple immunosuppression?

Anuja Java, MD: Following up on what Dr Nester mentioned, we are always worried about infections in these patients because as you said, as we know, these patients are on baseline immunosuppression to begin with. A few different things to keep in mind when we are using complement inhibition in transplant population or even in native kidneys, is that, as we've talked about, complement is part of innate immunity we are born with it, but as a person grows, your maturing adaptive immunity also starts playing a role in preventing infection. That's an important protective factor. The other thing depends on what inhibition you're using and which level that is. If you're using a C3 inhibitor, which is more central to the complement activation versus if you're using a more terminal inhibitor, you would worry that if you have a patient on a more C3 inhibitor, will that person be at a risk of broader infections. I would say that even though these drugs inhibit the complement system, they don't completely abolish the ac- abolish. There is even that little residual complement that you have is protective. And in our transplant population, my experience is that we've had a pretty good success with using these drugs, particularly patients that I take care of with atypical hemolytic UIC syndrome, where we use anti C5. And a very important factor is the vaccination. These patients are vaccinated, and the vaccination does bring down the risk of these infections, at least stand forward from what the literature shows. In addition, we keep our patients with prophylactic antibiotics. If you don't have enough time to vaccinate them and you must start the therapy, you could start them on antibiotics. And we keep our patients on antibiotics lifelong. There is a lot we can work with in using the inhibitors even in a more immunosuppressed population like the kidney transplant.

Transcript Edited for Clarity