Complement-Mediated Kidney Disease and Living Donor Transplantation: Tailoring Approaches to Improve Outcomes.

PURPOSE OF REVIEW

To provide a comprehensive update on the evaluation of kidney transplant recipients with complement-mediated kidney diseases and their living donor (LD) candidates.

RECENT FINDINGS

Atypical hemolytic syndrome (aHUS) and C3 glomerulopathy (C3G) are rare complement-mediated diseases characterized by excessive activation of the alternative complement pathway. The evaluation of living kidney donor candidates for complement-mediated kidney diseases is evolving in response to emerging evidence and advancements in risk assessment tools. Criteria once considered contraindications to living donation are now part of standard practice, while novel genetic markers and risk factors are being identified. For complement-mediated kidney diseases, genetic testing is particularly relevant as it can identify variants that influence disease recurrence risk and donor suitability. Despite these advances, data to guide the evaluation of LD candidates for aHUS and C3G are still very limited. The application and interpretation of novel genetic testing technologies remain in the early stages, and standardized guidance is lacking. In this review, we summarize the approach to LD kidney transplantation for complement-mediated kidney diseases, addressing utility of genetic testing, risks, and ongoing challenges for recipients and LDs.

SUMMARY

The present review highlights the importance and complexity of kidney transplantation from an LD for patients with complement-related kidney disorders and motivates further research to determine the optimal risk-assessment for LD candidates to recipients with aHUS and C3G.