Clinical Features and Outcomes of Recurrent IgA Nephropathy After Transplantation: A Case Series and Comparison to...

Recurrent IgA nephropathy (rIgAN) after kidney transplantation threatens long-term graft survival, yet contemporary clinicopathological descriptions are limited. We describe clinical, histological, and outcome features of rIgAN and compare them with native IgAN (nIgAN) in a single-center retrospective case series. Adults with biopsy-proven IgAN between 2010 and 2022 were included, comprising 21 adults with rIgAN and 63 with nIgAN. Demographic, clinical, and histopathological data, including Oxford MEST-C scores, were used, and patients were followed until kidney failure, death, or end of study. Patients with rIgAN were older at diagnosis and more frequently men. Kidney dysfunction at diagnosis was more advanced in rIgAN (creatinine was 227 μmol/L vs 128 μmol/L). Active inflammatory lesions mesangial and endocapillary hypercellularity were comparable between groups whereas chronic damage (segmental sclerosis and tubular atrophy) were more prevalent in rIgAN. Over follow-up, 52% of rIgAN patients progressed to kidney failure, with at a shorter median time (17 vs 50 months). Renal survival curves illustrated reduced graft survival in rIgAN. rIgAN was associated with a more aggressive clinical course and earlier graft failure. These findings underline the need for risk-adapted posttransplant surveillance and support evaluation of emerging nIgAN-directed therapies in the transplant setting.