Concurrent monoclonal paraproteinemia, persistent low complements: associated with early recurrence and increased graft loss. Soluble complement protein synthesized by the liver (i.e., Factor H, I, C3) have a high risk of recurrence similar to gain of function mutations in Factor B; living donor transplantation, even in the eculizumab era is not indicated in them. Extensive pre-transplant work-up for the components of the complement system and post-transplant protocol biopsy improves outcomes.