Recurrent IgA Nephropathy After Kidney Transplantation

Background. Immunoglobulin (Ig)A nephropathy is the most common primary glomerulonephritis worldwide, with a high recurrence rate after kidney transplantation. The aim of this study was to assess allograft survival, impact of recurrence on allograft function, and risk factors for post-transplant IgA recurrence. Methods. We identified 104 patients with IgA nephropathy who underwent kidney transplantation at our center between 1993 and 2014. Fourteen patients underwent more than one allograft. Results. IgA recurrence was documented in 23 (19%) allografts. Median time to recurrence was 6.75 years (interquartile range, 1.4-9.2 years). Twelve of the 23 recurrences were from living related donors (P =.07), and those with younger age at transplantation (37.7 +/- 2.3 vs 44 +/- 1.3, P=.05) were at higher risk of recurrence. Mean allograft survival was reduced in those with recurrence (6.5 +/- 5.1 years) compared with those without recurrence (10.4 +/- 7.5 years). At 6 years after transplant, allograft failure was documented in 52% of the recurrence group compared with 10% in the non-recurrence group (P=.002). Conclusions. IgA recurrence after transplant is an important cause of allograft loss. Living related donors and younger age at transplantation are associated with high recurrence rate. Close monitoring and treatment of recurrence are crucial.