Current Topics in TransplantationRenal transplantationRecurrent IgA Nephropathy After Kidney Transplantation

•In this retrospective study, we report the results of our patients with ESRD secondary to documented IgA nephropathy who underwent kidney transplantation at the Johns Hopkins Hospital between April 1993 and November 2014.•We present our center's experience of IgA recurrence after kidney transplantation in 104 patients who received one or more kidney transplantations in our center; during this period, 14 patients underwent repeat transplantation, and a total of 122 transplants were evaluated.•We identified the risk factors of recurrence and assessed allograft survival. IgA recurrence after transplant was associated with considerable allograft loss and a significant decrease in allograft survival. We also observed significant worsening of allograft function after recurrence.•Recurrence of IgA nephropathy should not be considered a benign finding.

BackgroundImmunoglobulin (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.MethodsWe identified 104 patients with IgA nephropathy who underwent kidney transplantation at our center between 1993 and 2014. Fourteen patients underwent more than one allograft.ResultsIgA 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).ConclusionsIgA 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.