KIDNEY TRANSPLANTATION IN PRESENCE OF COMPLEMENT GENE MUTATIONS IN BOTH RECIPIENTS AND THEIR ASYMPTOMATIC KIDNEY DONORS: OUR EXPERIENCE FROM CENTRAL INDIA

Introduction:

Mutations in the complement genes predispose to occurrence of the diseases like atypical hemolytic uremic syndrome (aHUS) which have a high likelihood of recurrence in transplanted kidney. It is unclear whether presence of such mutation in asymptomatic donors affect the outcomes of transplanted kidney. Also whether kidney donation surgery can put the donor at risk for development of aHUS is unknown. Here we assessed the presence of complement genes such complement factor H (CFH), B (CFB) and I (CFI) and complement factor related (CFHR) genes in prospective kidney donors and assessed the graft outcomes in the kidney transplant (KT) recipients.

Methods:

 We retrospectively assessed the database of our tertiary care transplant unit to identify the kidney donors and their recipients who had mutation in complement genes and CFHR genes. Graft outcomes in such pairs was assessed. The study was approved by the institutional ethics committee.

Results:

Between January 2020 and August 2024, 80 patients had presence of complement gene mutations. A total of seven donors with complement gene mutations with their respective recipients were identified. All the donors were mothers. Table 1 provides the profile of complement gene mutations in donors and their recipients. In transplant recipients, the graft developed thrombotic microangiopathy in only one (11.1%) patient. In this recipient, there was homozygous deletion in CFHR1 and 3 and had received graft from mother who had same mutation. With the use of plasma exchange and rituximab and other supportive therapy, the graft was salvaged. At latest follow-up of median 792 days (range: 324 to 1096 days), all recipients are alive with functioning graft. None of the donors developed any kidney dysfunction after graft retrieval surgery.  

Conclusions:

In presence of complement gene mutations that carry the risk of aHUS, donor assessment can be done to understand the profile of such mutations in close relatives. Despite presence of such mutations in donors and recipients, the likelihood of functioning graft of outcomes is excellent. Despite having complement gene mutations, the donors did not develop aHUS even after kidney retrieval surgery. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.