RECURRENT immunoglobulin A (IgA) nephropathy after kidney transplantation was associated with younger age at diagnosis, faster progression to kidney failure, and receipt of kidneys from living or genetically related donors in a Danish multicentre cohort study. The research assessed the incidence of biopsy confirmed recurrent IgA nephropathy and identified clinical and donor related factors associated with recurrence risk. The study evaluated contemporary transplantation data from two Danish centres to further characterise recurrence patterns among patients with previous IgA nephropathy.
The study included 118 adults with biopsy proven IgA nephropathy who received a first kidney only transplantation between 1990 and 2020 across two Danish transplantation centres. Patients were followed for a median of 5.5 years to evaluate recurrence and outcomes after transplantation.
Biopsy confirmed recurrent IgA nephropathy occurred in 14% of patients, with a cumulative incidence of 16% at 10 years after transplantation. Younger age at IgA nephropathy diagnosis, more rapid progression to kidney failure, and transplantation from a living or genetically related donor were independently associated with a higher risk of recurrence.
Maintenance steroid use after transplantation was not associated with recurrence risk in this cohort. However, recurrent IgA nephropathy was associated with an increased risk of graft failure compared with non-recurrent disease, with an unadjusted hazard ratio of 3.8 and an adjusted hazard ratio of 6.7. The study therefore identified recurrent nephropathy as an important factor associated with poorer graft outcomes after transplantation.
The investigators concluded that recurrent nephropathy remained a clinically significant challenge after kidney transplantation. The findings suggested that patient characteristics and donor related factors may help identify individuals at increased risk of recurrence.
Further larger and more diverse cohorts were needed to clarify donor related risk, strengthen evidence regarding immunosuppressive protocols, and guide strategies to improve graft outcomes for patients with IgA nephropathy. The study added to understanding of recurrence patterns and factors associated with outcomes following kidney transplantation.
Øhrstrøm MT et al. Incidence and risk factors for recurrent IgA nephropathy after kidney transplantation: A multicenter cohort study from Denmark. PLoS One. 2026;21(7):e0353887.
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