Introduction: IgA nephropathy (IgAN) is the most common glomerular disease globally, and its susceptibility and the risk for the development of end-stage kidney disease are related to genetic and environmental factors. IgAN recurrence after kidney transplantation is relatively common, impacting graft function and survival. This study evaluated the risk factors and the clinical, laboratory, and histological characteristics of post-transplant IgAN recurrence, considering the Oxford classification.

Methods: Retrospective single-center cohort study including kidney transplant recipients with biopsy-proven IgAN pre transplantation, with analysis of risk factors, clinical, laboratory, and histological characteristics of the IgAN recurrence cases.

Results: 53 fulfill the inclusion criteria and were included in the study. Majority was male, white, eutrophic, with a mean age of 27 + 9 years at diagnosis of IgAN. Systemic arterial hypertension and proteinuria were frequent in the pretransplant period. Four recipients (7.5%) presented IgAN recurrence in a period of 6 to 122 months posttransplant. According to the Oxford classification, they had high scores in the native kidney biopsies, and there was mesangial hypercellularity in all analyzed graft biopsies. None of these patients had received induction immunosuppressive therapy, and all of them presented graft failure in the follow-up.

Conclusions: In this series, despite the lower incidence of recurrence of IgAN posttransplant compared to previous reports, progression to graft loss was of 100%.