Complement therapy in transplant patients in C3G


Anuja Java, MD, discusses the role of complement inhibitors in transplant patients with C3G.

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

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