{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:20:43Z","timestamp":1787822443689,"version":"build-2784847793"},"reference-count":48,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["RD24\/0004\/0018"],"award-info":[{"award-number":["RD24\/0004\/0018"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>C3 glomerulopathy (C3G) is an ultra-rare, complement-mediated glomerular disease characterized by dysregulation of the alternative complement pathway and a high propensity for recurrence after kidney transplantation. Although kidney transplantation remains the optimal treatment for patients reaching kidney failure, post-transplant recurrence continues to be a major cause of graft dysfunction and loss. Over the past decade, improved histopathologic recognition and the increasing adoption of protocol biopsies have revealed that C3G frequently recurs early after transplantation, often in a subclinical form. At present, no validated clinical, genetic, or functional biomarkers reliably predict recurrence, and preventive strategies remain unproven. Consequently, from our standpoint, management of recurrent C3G requires a pragmatic, surveillance-driven approach rather than prophylactic intervention. In this review, we provide a practical framework for managing recurrent C3G after kidney transplantation, from transplant candidacy and pretransplant evaluation to post-transplant monitoring and therapeutic decision-making. We discuss the role of protocol biopsies, the limitations of conventional immunosuppression, and the emerging place of proximal complement inhibitors. Finally, we highlight several unmet needs that continue to limit optimal care, including persistent uncertainty about therapeutic goals, management of subclinical histologic recurrence, and interpretation of treatment response. This review reflects a transplant-centered clinical perspective aimed at supporting nephrologists in real-world decision-making.<\/jats:p>","DOI":"10.1093\/ndt\/gfag183","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:35:52Z","timestamp":1786448152000},"source":"Crossref","is-referenced-by-count":0,"title":["Management of recurrent C3 glomerulopathy after kidney transplantation"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3520-1422","authenticated-orcid":false,"given":"Hernando","family":"Trujillo","sequence":"first","affiliation":[{"name":"Department of Nephrology, Hospital Universitario 12 de Octubre , Madrid ,","place":["Spain"]},{"name":"RICORS2040-Renal, ISCIII , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Cavero","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario 12 de Octubre , Madrid ,","place":["Spain"]},{"name":"RICORS2040-Renal, ISCIII , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M","family":"Moran","sequence":"additional","affiliation":[{"name":"Cork University Hospital, University College Cork , Cork ,","place":["Republic of Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0362-8154","authenticated-orcid":false,"given":"Safak","family":"Mirioglu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University , Istanbul ,","place":["Turkey"]},{"name":"Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University , Istanbul ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Bruchfeld","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]},{"name":"Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5990-494X","authenticated-orcid":false,"given":"Stefanie","family":"Steiger","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine IV, Hospital of the Ludwig Maximilians University of Munich , Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2291-1692","authenticated-orcid":false,"given":"Kate I","family":"Stevens","sequence":"additional","affiliation":[{"name":"Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Frangou","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Limassol General Hospital, State Health Service Organization , Limassol ,","place":["Cyprus"]},{"name":"University of Nicosia Medical School , Nicosia ,","place":["Cyprus"]},{"name":"Medical School, National and Kapodistrian University of Athens , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7582-8476","authenticated-orcid":false,"given":"Luis F","family":"Quintana","sequence":"additional","affiliation":[{"name":"National Reference Centre on Complex Glomerular Disease (CSUR), Nephrology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kronbichler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck , Innsbruck ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9920-2195","authenticated-orcid":false,"given":"Y K","family":"Onno\u00a0Teng","sequence":"additional","affiliation":[{"name":"Center of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine \u2013 Nephrology Section, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9270-1071","authenticated-orcid":false,"given":"Manuel","family":"Praga","sequence":"additional","affiliation":[{"name":"Department of Medicine, Complutense University , 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