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World J Transplant. Sep 18, 2026; 16(3): 120969
Published online Sep 18, 2026. doi: 10.5500/wjt.120969
Published online Sep 18, 2026. doi: 10.5500/wjt.120969
Kidney transplant outcomes in patients with complement dysregulation
Manish Balwani, Amit Pasari, Department of Nephrology, Saraswati Kidney Care Center, Nagpur 440015, Mahārāshtra, India
Manish Balwani, Amit Pasari, Nishtha Manuja, Mohit Kurundwadkar, Shubham Dubey, Twinkle Pawar, Sunny Malde, Sushrut Gupta, Kapil Sejpal, Vijay Jeyachandran, Department of Nephrology, Jawaharlal Nehru Medical College, Wardha 442001, Mahārāshtra, India
Pranjal Kashiv, Department of Nephrology, All India Institute of Medical Sciences, Nagpur 441108, Mahārāshtra, India
Vishal Ramteke, Department of Nephrology, Max Super Speciality Hospital, Nagpur 440030, Mahārāshtra, India
Priyanka Tolani, Department of Internal Medicine, Jawaharlal Nehru Medical College, Wardha 442001, Mahārāshtra, India
Vivek B Kute, Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, Gujarat, India
Author contributions: Balwani M and Pasari A contributed to the conception, supervised patient management, provided senior oversight of data interpretation, and critically revised the manuscript for important intellectual content; Balwani M, Pasari A, and Kashiv P contributed to the design of the study; Kashiv P was responsible for data analysis, interpretation of results, drafting of the manuscript, and coordination of all stages of manuscript preparation and revision; Ramteke V and Tolani P contributed to patient evaluation, clinical data collection; Manuja N, Kurundwadkar M, Pawar T, Dubey S, Malde S, Gupta S, Sejpal K, Jeyachandran V, and Kute VB contributed to data acquisition and verification; Ramteke V, Tolani P, Kurundwadkar M, Pawar T, Dubey S, Malde S, Gupta S, Sejpal K, Jeyachandran V, and Kute VB contributed to the critical review of the manuscript; Kurundwadkar M, Pawar T, Dubey S, Malde S, Gupta S, Sejpal K, Jeyachandran V, and Kute VB contributed to patient management; All authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work.
AI contribution statement: AI tools including ChatGPT and Grammarly were used in a limited capacity for language refinement, grammatical correction, and improvement of readability of the manuscript text. All scientific concepts, clinical observations, data interpretations, and conclusions are the original work of the authors. The authors take full responsibility for the entire content of the manuscript.
Institutional review board statement: The study protocol was reviewed by the SKCC Institutional Ethics Committee, SS Multispecialty Hospital, Nagpur, Maharashtra, India (approval No. ECR/1725/Inst/MH/2022), and was granted exemption from full review due to its retrospective design involving anonymized clinical data.
Informed consent statement: The requirement for individual informed consent was waived by the Institutional Ethics Committee owing to the retrospective nature of the study and use of anonymized data.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Manish Balwani, MD, DM, Professor, Department of Nephrology, Saraswati Kidney Care Center, Near Jai Prakash Metro Station, Nagpur 440015, Mahārāshtra, India. balwani.manish@yahoo.com
Received: March 12, 2026
Revised: May 3, 2026
Accepted: June 12, 2026
Published online: September 18, 2026
Processing time: 172 Days and 3.3 Hours
Revised: May 3, 2026
Accepted: June 12, 2026
Published online: September 18, 2026
Processing time: 172 Days and 3.3 Hours
Core Tip
Core Tip: Complement dysregulation is an important but underrecognized determinant of post-transplant thrombotic microangiopathy. In this retrospective cohort of 38 kidney transplant recipients with complement dysregulation, CFHR1-CFHR3 structural variants predominated, anti-factor H antibodies were frequent, and recurrence occurred in 18.4%. All recurrences developed within the first 1-3 weeks post-transplant and were confined to recipients with complement genetic abnormalities. All episodes were successfully controlled with individualized therapy. Overall patient survival was 94.7%. These findings support systematic complement evaluation, biologic risk stratification, and early targeted intervention to optimize transplant selection, reduce recurrence risk, and improve post-transplant graft outcomes in complement-mediated kidney disease.