Navigating Eligibility and the Evaluation Process The Evaluation Process There are two ways to obtain a kidney for transplant: either from a person who has recently died and made the decision to be an organ donor or from a living person who has two healthy kidneys. With either, the recipient must be evaluated at a transplant center and approved for the transplant waitlist. In most cases, a potential living donor needs to be evaluated also.e60dc2a1-f33c-4a05-9b50-8e3e8e597629508a7d29-49b8-4cd5-be08-3d57566782f0 Physical Health You’ll be thoroughly checked out to make sure you can tolerate a transplant procedure. You’ll have blood tests, imaging tests, evaluations of your kidney function, blood and tissue type compatibility testing, screenings for certain cancers, and testing for the presence of infections (such as hepatitis B or C and HIV).e60dc2a1-f33c-4a05-9b50-8e3e8e59762905ec3d26-6661-42d1-baab-29b5dc3b4306 Mental Health Transplantation is a life-changing event, and you’ll be evaluated to make sure you’re mentally ready for a kidney transplant, can cope with the stress of undergoing a transplant, and can participate in your care afterward.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3e17993-83c1-4c29-bf10-8f107ca36f19 Financial Considerations Transplants and their associated care are very expensive. The transplant team may have you meet with a financial counselor or social worker to discuss your health insurance coverage and out-of-pocket costs, and, if needed, resources to help cover the cost.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3e17993-83c1-4c29-bf10-8f107ca36f19 If you’re declared a good candidate for transplant, you may be added to the national waiting list for a donor kidney. However, if you already have a living donor lined up, the transplant can proceed as soon as you both are ready. Patients with C3G and IC-MPGN follow the same procedures as anyone else when transplant is being considered. However, there is a high risk that these diseases will recur after transplant.e60dc2a1-f33c-4a05-9b50-8e3e8e59762975cf84b0-6597-4652-bbfd-9e48408264d7 While it might be helpful to normalize levels of immune system proteins before a transplant, it is not a requirement. It’s not yet clear what role these levels play in the risk of recurrence.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d4abb1db-d41a-4a02-bb57-1f63f55261b9
The Takeaway A kidney transplant can improve your quality of life when you have C3G or IC-MPGN, but it doesn’t cure the underlying disease and there is a high risk of recurrence after transplantation. Newer medications called complement inhibitors have demonstrated promising results in clinical trials and may be effective in controlling disease recurrence. Regularly scheduled biopsies can detect the earliest signs of recurrence and may allow for prompt interventions.
Immunosuppression Immunosuppression Managing your immune system is an important aspect of kidney transplant with C3G and IC-MPGN. It’s your body’s first line of defense against foreign invaders, such as bacteria and viruses, targeting and attacking anything that doesn’t belong in your body.e60dc2a1-f33c-4a05-9b50-8e3e8e597629567576b9-bab4-4971-b979-7d8693270be8 Your immune system also sees your new kidney as a foreign invader. To protect the kidney and keep your body from attacking (rejecting) it, you’ll take medications called immunosuppressants for the rest of your life or as long as you have the transplanted kidney. While these medicines will weaken your immune system, it will still function well enough to prevent you from getting serious infections. Induction Therapy To get your body ready to accept the new kidney, you’ll have strong antirejection medicine called induction therapy administered intravenously before you receive your transplant and one or more times immediately after surgery. Maintenance Therapy You’ll shift to maintenance therapy while you’re in the hospital, and you’ll be responsible for taking this oral medication when you get home, for as long as you have the new kidney. Several different immunosuppressants can be prescribed, and most people will need to take a combination of medications for the best results. “Our standard protocols include induction therapy with thymoglobulin in most patients, and then they are maintained on maintained on Prograf [tacrolimus], CellCept [mycophenolate mofetil] and prednisone,” says Stanley Jordan, MD , director of nephrology and medical director of the kidney transplant program at Cedars-Sinai Medical Center in Los Angeles. “This accounts for more than 95 percent of renal transplants in the U.S.”
Long-Term Outlook and Quality of Life Long-Term Outlook After a kidney transplant, it’s important to take antirejection medications as prescribed to lower your risk of organ rejection, and to watch for signs of C3G or IC-MPCG recurrence. Your doctor may recommend periodic biopsies, which can detect recurrence even before you have symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e59762906268403-1d16-4623-b329-47e2e46aee37 The outlook for patients post-transplant remains challenging, but the new complement inhibitors hold promise in improving outcomes. Pegcetacoplan and iptacopan have only recently become available, and data about their effectiveness is especially limited for people who have received transplants. Clinical trials are also looking at new potential complement inhibitors and other experimental therapies.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f1a4d5fb-a19d-4d5d-9345-bb30a3e7efc0 Jordan is optimistic about the future for these patients. “The long-term outlook and quality of life with a transplant is excellent,” he says. “For example, the life-saving benefits of kidney transplantation are significant. Here, life expectancy is sixfold higher than patients remaining on dialysis. Anything we can do to transplant and preserve kidney function has a lifesaving benefit for the patients.” Qazi agrees. “Kidney transplant offers a better quality of life and more years of life, compared to remaining on dialysis,” he says. “Certain conditions can recur in the kidney transplant shortening the lifespan of the transplant, but newer therapies such as the complement inhibitors can prevent this recurrence and stabilize the kidney transplant, allowing patients to enjoy a dialysis-free life.”
Understanding Recurrence Risk Recurrence Risk A transplant only replaces the kidney — it doesn’t address the underlying cause of C3G or IC-MPGN. There’s a good chance that the immune system dysfunction that leads to these conditions will also damage the new kidney. Estimates vary, but studies have shown the risk of recurrence after a transplant to be as high as 45 percent with IC-MPGN and 89 percent with C3G.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915f12326-de4a-441d-9902-891bea857b09 Recurrence can happen soon after the transplant — within the first few months — and about half the time it eventually leads to failure in the new kidney.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915f12326-de4a-441d-9902-891bea857b09e60dc2a1-f33c-4a05-9b50-8e3e8e59762934c27aa7-ab84-4000-8144-b99474c2d8b1 “Recurrent glomerular diseases are not uncommon in kidney transplant and can account for about 15 percent of kidney transplant loss long-term,” says Dr. Jordan. “C3GN/IC-MPGN are a very difficult group of diseases with poorly understood pathogenesis. However, we know that soluble factors, most likely antibodies to complement regulatory proteins, can persist in the patient’s body and reinitiate disease after transplant.”
Protecting the New Kidney: New Drugs and Emerging Therapies Protecting the New Kidney There’s no established way to predict or prevent C3G or IC-MPGN recurrence. However, new drugs called complement inhibitors that target immune system dysfunction have potential to reduce the risk.e60dc2a1-f33c-4a05-9b50-8e3e8e597629515c7d63-5399-45ff-bbad-cf27cfba62b6 “The new inhibitors prevent the series of reactions also known as the complement cascade, and prevent abnormal proteins from accumulating in the kidney,” says Dr. Qazi, “thus preventing inflammation and damage. The drugs are approved [by the U.S. Food and Drug Administration] for these conditions.” Iptacopan (Fabhalta) was approved in March 2025 to treat C3G, and pegcetacoplan (Empaveli) was approved in July 2025 for both C3G and IC-MPGN. Studies show they can reduce damage to your kidneys’ filtering mechanisms and stabilize kidney function, but it’s still not known what they will mean for patients with transplanted kidneys.e60dc2a1-f33c-4a05-9b50-8e3e8e59762980d28863-d894-43d9-a8fd-0c7b7b71f5a3e60dc2a1-f33c-4a05-9b50-8e3e8e597629114c93bf-f216-41be-a8b2-609ddf14c357 One clinical trial looked at how effective pegcetacoplan was in 10 patients with recurrent C3G or IC-MPGN after a transplant. After 12 weeks on the medication, blood and urine tests showed signs of disease improvement.e60dc2a1-f33c-4a05-9b50-8e3e8e59762951ed58e2-d7e5-4128-81e5-a126163a05a2 Iptacopan was evaluated in a group of 10 patients with recurrent C3G after a transplant. At 12 months, their disease biomarkers had also improved.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290e1f9071-f376-47aa-9609-f1a8d951373f
Transplant Risks Transplant Risks Kidney transplants have risks, as all surgeries do. They include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762930e8ba71-ead8-4fe0-b7c4-969d363a0312 Infection due to immunosuppression Surgical complications such as pain, bleeding, and infection at the surgical site Organ rejection, which can lead to loss of the transplanted kidney “Surgical complications like wound infections and more rarely thrombosis of the arterial or venous anastomosis are possible though the overall numbers are very small,” says Yasir A. Qazi, MD , a transplant nephrologist at Providence St. Joseph Hospital in Orange, California, and an associate professor of clinical medicine at Keck School of Medicine of USC. “With improvement in immunosuppression, the rejection rates have gone down into the teens, but with more potent immunosuppression, patients are now at higher risks of infections and cancers.” Studies show that about a third of people who undergo kidney transplant surgery will develop an infection within three months, most commonly a urinary tract infection.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a450aac9-ec14-4aca-85ca-fe62d883793c That’s attributed in part to the immunosuppressant medications that help keep your body from attacking the new kidney — but also lower your ability to fight off infections.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291fd7f9c4-6738-4404-bcd3-3c104aa2d0d7 Even with immunosuppression, organ rejection can still happen. “Rejection is more common during the first year after transplant, but modern immunosuppression is decreasing this,” says Rossana Malatesta Muncher, MD , a pediatric nephrologist at Texas Children’s and an assistant professor at Baylor College of Medicine in Houston. “Rejections can present with an acute kidney injury or be found with surveillance testing or a biopsy.” This complication can happen at different stages of the transplant process and for different reasons.e60dc2a1-f33c-4a05-9b50-8e3e8e59762939fae32b-9c3b-493e-88b4-0e8f0a63d79d Hyperacute rejection happens within minutes after a transplant. It’s mainly related to incompatibility between donor and recipient, and is now rare as matching has become more accurate. Acute rejection can happen at any point following the transplant, although usually within days or weeks. Chronic rejection usually develops more than three months after transplant, but can happen years after the procedure. This type of rejection is gradual, and the signs may be hard to notice. Acute rejection has two different causes. “Acute cellular rejection happens when immune cells directly recognize the foreign kidney and attack it,” says Dr. Malatesta Muncher. “Antibody-mediated rejection occurs when donor-specific antibodies attach to the kidney and start an immunological injury.” Both acute and chronic rejection can be treated if they’re identified in time, but they can also cause you to lose the new kidney.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294c668ea8-7a88-4b7c-9cd4-a1a8b1933c28
Both C3 glomerulopathy (C3G) and immune complex membranoproliferative glomerulonephritis (IC-MPGN) are chronic and progressive diseases that damage the filtering system of your kidneys. Some people with these diseases eventually go into kidney failure and need to go on dialysis or get a kidney transplant.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292b456358-34ef-4dd1-afd9-535d8ba50e23 A transplant is often preferable to dialysis. While dialysis is a life-saving measure, it’s a lifetime commitment, and it has potential risks and complications.e60dc2a1-f33c-4a05-9b50-8e3e8e59762914162fc8-11d6-47d4-85be-6d2bf0c4802f Your doctor determines whether you’re in kidney failure based on tests that measure the ability of your kidneys to filter toxins from your blood.e60dc2a1-f33c-4a05-9b50-8e3e8e59762980e427da-f4e7-4f64-a3ef-410d9dca77d6 Some people are eligible for what’s known as a “preemptive” kidney transplant, which happens before your kidneys have failed. An “early transplant” is done after your kidneys have failed, but you’ve only been on dialysis a short time. Both of these options have benefits, as these people tend to receive their new kidneys when their health is generally good and have better outcomes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d8421261-f423-44f0-a1cc-c2494d6e13a7
Resources We Trust Cleveland Clinic: Kidney FailureMayo Clinic: Deceased Donor Kidney TransplantNational Kidney Foundation: Preemptive TransplantAmerican Kidney Fund: Preparing for Transplant: Evaluation, Finding a Match, Costs and SurgeryJohns Hopkins Medicine: Kidney Transplant
The Procedure: What to Expect During and After Surgery The Procedure A kidney transplant is a major operation:e60dc2a1-f33c-4a05-9b50-8e3e8e59762993540ec8-fa99-4194-b36b-ff91f68b20ece60dc2a1-f33c-4a05-9b50-8e3e8e597629b4f0ad7f-f84c-4b6b-8362-fde550b81fe3 You’ll have general anesthesia, meaning that you’ll be asleep for the entire procedure. The surgeon places the donor kidney into your lower abdomen and attaches it to the blood vessels that lead to one of your legs. The tube that carries urine out of the new kidney (ureter) is attached to your bladder. Your own kidneys stay in place, unless they’re causing complications such as high blood pressure, kidney stones, or an infection. The surgery takes about three to four hours. Your new kidney may start making urine immediately; if not, you may need dialysis for a few days. You’ll spend at least several days in the hospital as you recover.
Kidney Transplant for C3G/IC-MPGN: What You Need to Know
