What is the recurrence time of Immunoglobulin A (IgA) nephropathy after kidney transplantation?

From the Guidelines

IgA nephropathy can recur in transplanted kidneys, with a risk ranging from 0.006 to 0.1 per patient per year, as reported in the most recent study 1.

Recurrence Time and Risk Factors

The recurrence time of IgA nephropathy after kidney transplantation is not strictly defined, but the risk of recurrence is relatively low.

• The risk of recurrent disease in the allograft and extrarenal flares is low, ranging from 0.006 to 0.1 per patient per year, according to the 2023 study 1.
• The study also recommends delaying transplant until the patient has been in extrarenal remission for 12 months to minimize the risk of recurrence.
• Risk factors for recurrence are not explicitly stated in the provided evidence, but regular monitoring through urinalysis, blood pressure checks, and serum creatinine measurements is essential for early detection.

Monitoring and Treatment

• The 2010 guideline 1 suggests screening kidney transplant recipients with primary kidney disease caused by IgA nephropathy for microhematuria at least once in the first month, every 3 months during the first year, and annually thereafter.
• When screening suggests possible treatable recurrent disease, an allograft biopsy is recommended 1.
• Treatment of recurrent kidney disease may include plasma exchange, high-dose corticosteroids, cyclophosphamide, or angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) 1.

Outcome and Quality of Life

• Despite the risk of recurrence, kidney transplantation remains the best treatment option for end-stage kidney disease due to IgA nephropathy, with good long-term outcomes in most patients.
• The underlying immune dysregulation that caused the original disease persists in the patient, leading to abnormal IgA production and deposition in the new kidney, but this does not necessarily affect the quality of life of the patient.

From the Research

Recurrence Time of Immunoglobulin A (IgA) Nephropathy after Kidney Transplantation

• The recurrence time of IgA nephropathy after kidney transplantation can vary, with some cases recurring as early as 19 days after transplantation 2.
• The prevalence of post-transplant recurrence approaches 15% at ten years post-transplant 3.
• The risk for IgAN recurrence was 27.7% (95%-CI: 20.6-35.3%) after 11 years 4.
• Recurrence of IgAN is a more significant cause of allograft failure than previously believed, with the recurrence rate varying from 1% to 10% per year 5.
• Recurrent IgAN rarely manifests clinically before 3 years post transplantation, with a recurrence rate estimated to be around 30% 6.

Factors Influencing Recurrence

• Younger recipients and women had a higher risk of recurrence, but the latter only in the short term 4.
• Young age at renal transplant, rapid progression of the original disease, and higher levels of circulating galactose-deficient IgA1 and IgA-IgG immune complexes are all associated with a higher rate of recurrence 5, 6.
• Serum concentration of total IgA, total IgG, Gd-IgA1, and IgA-IgG immune complex within the first year posttransplant showed no significant effect on the recurrence of IgAN 4.

Clinical Characteristics and Risk Factors

• IgA nephropathy is the most common form of glomerulonephritis worldwide, progressing to end-stage kidney disease in 20-40% of patients within 20 years of diagnosis 5.
• Patients with IgA nephropathy are ideal candidates for renal transplant because they are generally relatively young and with few comorbidities 6.
• Graft survival is better or comparable to that of controls at 10 years, though few data are available after 10 years of follow-up 6.