Graft Outcomes in For-Cause Biopsy-Proven Recurrent IgA Nephropathy After Kidney Transplantation: Rare but Clinically...

Recurrent IgA nephropathy (IgAN) after kidney transplantation has been reported in up to 20%-60% of recipients, through incidence varies by surveillance strategy. We aimed to define the incidence and clinical impact of biopsy-proven recurrence IgAN in a single center cohort.

We performed retrospective review of renal allograft biopsies performed at UCLA between 2020 and 2025. A total of 1474 patients underwent kidney allograft biopsies for clinical reasons. 40 patients had biopsy-proven recurrent IgAN and were included in analysis. Clinical, laboratory and histopathologic features at recurrence were analyzed for association with graft failure using Kaplan-Meier. Time-to event analyses were performed using Cox regression.

Biopsy-proven recurrent IgAN was identified in 40 of 1474 for-cause biopsy recipients (2.7%). Graft failure occurred in 10 of 40 patients (25.0%) over a median follow-up of 5.57 years. Median time from recurrence to graft failure was 2.46 years. Graft loss was attributed primarily to recurrent IgAN in 7 patients (70.0%) and associated with rejection in 3 (30.0%). IFTA >50% was the only significant predictor of graft failure (HR 4.00, 95% CI 1.12-14.27; p = 0.03). Rising creatinine, proteinuria, hematuria, Asian race, and C3 bright deposition showed non-significant trends toward worse graft survival.

In this for-cause biopsy cohort, clinically detected recurrent IgAN was associated with meaningful graft loss. Severe chronic injury at recurrence identified patients with poorer prognosis, although this likely reflects advanced nonspecific allograft damage rather than a recurrence-specific mechanism.