Publication Name	World Journal of Transplantation
Manuscript ID	117138
Country	United States

Category	Transplantation
Manuscript Type	Review
Article Title	C3 glomerulopathy in transplant “like yet unlike native”: Pathophysiology, recent advances in therapeutics and evolving paradigms
Manuscript Source	Unsolicited Manuscript
All Author List	Arun Chutani, Sayna Norouzi and Edgar V Lerma
Funding Agency and Grant Number
Corresponding Author	Arun Chutani, Assistant Professor, FACP, FASN, MD, Renal Medicine, UMass Chan Medical School, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, United States. docarun26@gmail.com
Key Words	C3 glomerulopathy; Alternate pathway; Complement; Iptacopan; Pegcetocoplan
Core Tip	C3 glomerulopathy is the most frequent recurrent glomerular disease after kidney transplantation, with recurrence rates up to 90%. Its pathogenesis is driven by alternative complement pathway dysregulation, influenced by genetic mutations, autoantibodies, monoclonal gammopathy, and transplant-specific triggers such as ischemia-reperfusion injury and viral infections. Histopathology in the allograft often shows subtler C3 deposition compared with native disease, underscoring the need for protocol biopsies. Traditional immunosuppression offers limited benefit, while novel complement-targeted therapies - including factor B inhibitors (iptacopan), C3 inhibitors (pegcetacoplan), and factor D inhibitors - represent a paradigm shift. Early case reports in transplant recipients demonstrate promising outcomes, highlighting the importance of personalized medicine and early intervention to preserve graft survival.
Citation	Chutani A, Norouzi S, Lerma EV. C3 glomerulopathy in transplant “like yet unlike native”: Pathophysiology, recent advances in therapeutics and evolving paradigms. World J Transplant 2026; In press

Received	2025-12-02 02:25
Peer-Review Started	2025-12-02 02:25
First Decision by Editorial Office Director	2025-12-19 08:11
Return for Revision	2025-12-19 08:11
Revised	2026-02-10 03:32
Publication Fee Transferred	2026-02-11 23:03
Second Decision by Editor	2026-04-07 02:38
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-04-07 10:23
Articles in Press	2026-04-07 10:23
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Typeset the Manuscript

ISSN	2220-3230 (online)
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