{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:42:01Z","timestamp":1790764921205,"version":"4.1.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2019,11,4]],"date-time":"2019-11-04T00:00:00Z","timestamp":1572825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Postgraduate Institute of Medical Education and Research","award":["71\/08-Edu-15\/1737"],"award-info":[{"award-number":["71\/08-Edu-15\/1737"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Complement 3 glomerulopathy (C3G) results from dysfunction of the alternative complement pathway (ACP). No data are available on post-transplant C3G in South Asia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this study, renal allograft biopsies of C3G patients performed from 2012 to 2017 were analysed for ACP functional assay (APFA), serum complement levels, complement factor H (CFH), complement factor B (CFB) and autoantibodies to CFH and CFB. Limited genetic screening for CFH\/CFHR5 genes was carried out. All study patients were also followed up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 21 cases of C3G were included, of which 11 had native C3G disease (that is, recurrent C3G). Of these 11 recurrent cases, 7 presented with allograft dysfunction and 4 with proteinuria and renal dysfunction. Early post-transplant recurrence (&amp;lt;1\u2009month) was noted in six patients, whereas recurrence in five patients occurred within 8\u201317\u2009months of transplant. Biopsies showed mild focal mesangial expansion with or without endocapillary proliferation and thrombotic microangiopathy. Rejection was also noted in six patients. APFA\/C3 levels were low in all cases. Serum CFH levels were low [dense deposit disease (DDD), 44%; C3 glomerulonephritis (C3GN), 25%], whereas CFB levels were normal. Autoantibodies to CFH, CFB and C3 nephritic factor were present in 11, 0 and 44% of DDD cases, respectively, and in 17, 17 and 33% of C3GN cases, respectively. Genetic analysis revealed only non-pathogenic CFH gene variants (93%). No novel mutation was found. At follow-up (140\u2009months), stable graft was noted in 28% of cases, progressive renal failure in 19%, graft loss in 34%, and 19% of patients died.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Post-transplant C3G can present with graft dysfunction and\/or proteinuria. Subtle histological findings demand careful interpretation of immunofluorescence results. Autoantibodies to complement pathway regulatory proteins are common, and no novel mutation has been found from limited genetic workup. Clinical outcome is poor.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfz135","type":"journal-article","created":{"date-parts":[[2019,9,7]],"date-time":"2019-09-07T11:49:23Z","timestamp":1567856963000},"page":"291-300","source":"Crossref","is-referenced-by-count":15,"title":["Poor allograft outcome in Indian patients with post-transplant C3 glomerulopathy"],"prefix":"10.1093","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0086-7398","authenticated-orcid":false,"given":"Ashwani","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Histopathology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1273-9107","authenticated-orcid":false,"given":"Raja","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Department of Nephrology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Rawat","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reena","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Hematology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charan S","family":"Rayat","sequence":"additional","affiliation":[{"name":"Department of Histopathology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepesh B","family":"Kenwar","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishan L","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Nephrology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritambhra","family":"Nada","sequence":"additional","affiliation":[{"name":"Department of Histopathology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,11,4]]},"reference":[{"key":"2021020321171168600_sfz135-B1","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1038\/ki.2012.63","article-title":"Acquired and genetic complement abnormalities play a critical role in dense deposit disease and other C3 glomerulopathies","volume":"82","author":"Servais","year":"2012","journal-title":"Kidney Int"},{"key":"2021020321171168600_sfz135-B2","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/ki.2012.212","article-title":"C3 glomerulonephritis: clinicopathological findings, complement abnormalities, glomerular proteomic profile, treatment, and follow-up","volume":"82","author":"Sethi","year":"2012","journal-title":"Kidney Int"},{"key":"2021020321171168600_sfz135-B3","doi-asserted-by":"crossref","first-page":"265","DOI":"10.2215\/CJN.07900811","article-title":"Causes of alternative pathway dysregulation in dense deposit disease","volume":"7","author":"Zhang","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"2021020321171168600_sfz135-B4","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1681\/ASN.2013070715","article-title":"Clinical findings, pathology, and outcomes of C3GN after kidney transplantation","volume":"25","author":"Zand","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"2021020321171168600_sfz135-B5","doi-asserted-by":"crossref","first-page":"3811","DOI":"10.1093\/ndt\/gfr436","article-title":"Three kidneys, two diseases, one 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