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IgA nephropathy: Recurrence after transplantation

Rowena Delos Santos, MD
Daniel C Brennan, MD, FACP
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD


Transplantation is the treatment of choice for individuals with progressive renal failure due to IgA nephropathy (IgAN), which is caused by the deposition of IgA in the kidney parenchyma. Recurrent IgA deposition in the allograft is common and may cause hematuria, proteinuria, or progressive renal dysfunction. Among some patients, however, IgA deposits are observed on biopsy, but do not appear to cause clinically significant disease. [1]. IgA deposition may occur alone or be concurrent with other significant pathology, including chronic rejection.

Issues related to recurrence after transplantation in patients with IgAN or Henoch-Schönlein purpura (IgA vasculitis [IgAV] or HSP) are reviewed here. The pathogenesis, treatment, and prognosis of this disorder are discussed separately. (See "Pathogenesis of IgA nephropathy" and "Treatment and prognosis of IgA nephropathy".)


There have been no large, prospective studies defining the risk of recurrence in patients with IgAN who receive either a living-donor or deceased-donor renal allograft. The reported frequency of histologic or clinically significant recurrence of IgAN varies in the reported literature, with the incidence probably increasing as a function of time from transplantation [2-4].

Histologic recurrence, with or without evidence of clinical disease, is common. As an example, in a combined retrospective and prospective study that reviewed biopsies from 29 allografts, histologic recurrence of IgA deposition was found in 17 patients (58 percent) [5]. Three of these patients had a normal urinalysis and normal glomeruli on light microscopy, while five had hematuria, heavy proteinuria, hypertension, and progressive renal failure due to IgAN alone. The only predictor for recurrence was a longer time after transplantation (46 versus 15 months in those without recurrence).

In retrospective analyses of allograft biopsies obtained due to clinical concern for graft dysfunction, the recurrence of IgAN has ranged from 21 to 58 percent [5-10].

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Literature review current through: Nov 2017. | This topic last updated: Jul 24, 2015.
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  1. Kowalewska J, Yuan S, Sustento-Reodica N, et al. IgA nephropathy with crescents in kidney transplant recipients. Am J Kidney Dis 2005; 45:167.
  2. Andresdottir MB, Haasnoot GW, Doxiadis II, et al. Exclusive characteristics of graft survival and risk factors in recipients with immunoglobulin A nephropathy: a retrospective analysis of registry data. Transplantation 2005; 80:1012.
  3. Koch MJ. Considerations in retransplantation of the failed renal allograft recipient. Adv Chronic Kidney Dis 2006; 13:18.
  4. Choy BY, Chan TM, Lai KN. Recurrent glomerulonephritis after kidney transplantation. Am J Transplant 2006; 6:2535.
  5. Odum J, Peh CA, Clarkson AR, et al. Recurrent mesangial IgA nephritis following renal transplantation. Nephrol Dial Transplant 1994; 9:309.
  6. Kim YS, Moon JI, Jeong HJ, et al. Live donor renal allograft in end-stage renal failure patients from immunoglobulin A nephropathy. Transplantation 2001; 71:233.
  7. Kessler M, Hiesse C, Hestin D, et al. Recurrence of immunoglobulin A nephropathy after renal transplantation in the cyclosporine era. Am J Kidney Dis 1996; 28:99.
  8. Bumgardner GL, Amend WC, Ascher NL, Vincenti FG. Single-center long-term results of renal transplantation for IgA nephropathy. Transplantation 1998; 65:1053.
  9. Frohnert PP, Donadio JV Jr, Velosa JA, et al. The fate of renal transplants in patients with IgA nephropathy. Clin Transplant 1997; 11:127.
  10. Moroni G, Longhi S, Quaglini S, et al. The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival. Nephrol Dial Transplant 2013; 28:1305.
  11. Kasiske BL, Snyder JJ, Matas AJ, et al. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol 2002; 13:1358.
  12. Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 2001; 344:726.
  13. Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation 2002; 74:1377.
  14. Ponticelli C, Traversi L, Feliciani A, et al. Kidney transplantation in patients with IgA mesangial glomerulonephritis. Kidney Int 2001; 60:1948.
  15. Freese P, Svalander C, Nordén G, Nyberg G. Clinical risk factors for recurrence of IgA nephropathy. Clin Transplant 1999; 13:313.
  16. Andresdottir MB, Hoitsma AJ, Assmann KJ, Wetzels JF. Favorable outcome of renal transplantation in patients with IgA nephropathy. Clin Nephrol 2001; 56:279.
  17. Wang AY, Lai FM, Yu AW, et al. Recurrent IgA nephropathy in renal transplant allografts. Am J Kidney Dis 2001; 38:588.
  18. McDonald SP, Russ GR. Recurrence of IgA nephropathy among renal allograft recipients from living donors is greater among those with zero HLA mismatches. Transplantation 2006; 82:759.
  19. Han SS, Huh W, Park SK, et al. Impact of recurrent disease and chronic allograft nephropathy on the long-term allograft outcome in patients with IgA nephropathy. Transpl Int 2010; 23:169.
  20. Brensilver JM, Mallat S, Scholes J, McCabe R. Recurrent IgA nephropathy in living-related donor transplantation: recurrence or transmission of familial disease? Am J Kidney Dis 1988; 12:147.
  21. Matsugami K, Naito T, Nitta K, et al. [A clinicopathological study of recurrent IgA nephropathy following renal transplantation]. Nihon Jinzo Gakkai Shi 1998; 40:322.
  22. Hiki Y, Kobayashi Y, Ookubo M, et al. Association of HLA-DQw4 with IgA nephropathy in the Japanese population. Nephron 1991; 58:109.
  23. Hiki Y, Kobayashi Y, Ookubo M, Kashiwagi N. The role of HLA-DR4 in the long-term prognosis of IgA nephropathy. Nephron 1990; 54:264.
  24. Andresdottir MB, Haasnoot GW, Persijn GG, Claas FH. HLA-B8, DR3: a new risk factor for graft failure after renal transplantation in patients with underlying immunoglobulin A nephropathy. Clin Transplant 2009; 23:660.
  25. Ortiz F, Gelpi R, Koskinen P, et al. IgA nephropathy recurs early in the graft when assessed by protocol biopsy. Nephrol Dial Transplant 2012; 27:2553.
  26. Berger J. Recurrence of IgA nephropathy in renal allografts. Am J Kidney Dis 1988; 12:371.
  27. Nowack R, Birck R, van der Woude FJ. Mycophenolate mofetil for systemic vasculitis and IgA nephropathy. Lancet 1997; 349:774.
  28. Hauser IA, Renders L, Radeke HH, et al. Mycophenolate mofetil inhibits rat and human mesangial cell proliferation by guanosine depletion. Nephrol Dial Transplant 1999; 14:58.
  29. Vongwiwatana A, Gourishankar S, Campbell PM, et al. Peritubular capillary changes and C4d deposits are associated with transplant glomerulopathy but not IgA nephropathy. Am J Transplant 2004; 4:124.
  30. Chandrakantan A, Ratanapanichkich P, Said M, et al. Recurrent IgA nephropathy after renal transplantation despite immunosuppressive regimens with mycophenolate mofetil. Nephrol Dial Transplant 2005; 20:1214.
  31. Pham PT, Pham PC. The impact of mycophenolate mofetil versus azathioprine as adjunctive therapy to cyclosporine on the rates of renal allograft loss due to glomerular disease recurrence. Nephrol Dial Transplant 2012; 27:2965.
  32. Mulay AV, van Walraven C, Knoll GA. Impact of immunosuppressive medication on the risk of renal allograft failure due to recurrent glomerulonephritis. Am J Transplant 2009; 9:804.
  33. Clayton P, McDonald S, Chadban S. Steroids and recurrent IgA nephropathy after kidney transplantation. Am J Transplant 2011; 11:1645.
  34. Berthoux F, El Deeb S, Mariat C, et al. Antithymocyte globulin (ATG) induction therapy and disease recurrence in renal transplant recipients with primary IgA nephropathy. Transplantation 2008; 85:1505.
  35. Pascual J, Mezrich JD, Djamali A, et al. Alemtuzumab induction and recurrence of glomerular disease after kidney transplantation. Transplantation 2007; 83:1429.
  36. Díaz-Tejeiro R, Maduell F, Diez J, et al. Loss of renal graft due to recurrent IgA nephropathy with rapidly progressive course: an unusual clinical evolution. Nephron 1990; 54:341.
  37. Streather CP, Scoble JE. Recurrent IgA nephropathy in a renal allograft presenting as crescentic glomerulonephritis. Nephron 1994; 66:113.
  38. Ohmacht C, Kliem V, Burg M, et al. Recurrent immunoglobulin A nephropathy after renal transplantation: a significant contributor to graft loss. Transplantation 1997; 64:1493.
  39. Oka K, Imai E, Moriyama T, et al. A clinicopathological study of IgA nephropathy in renal transplant recipients: beneficial effect of angiotensin-converting enzyme inhibitor. Nephrol Dial Transplant 2000; 15:689.
  40. Courtney AE, McNamee PT, Nelson WE, Maxwell AP. Does angiotensin blockade influence graft outcome in renal transplant recipients with IgA nephropathy? Nephrol Dial Transplant 2006; 21:3550.
  41. Ng R. Fish oil therapy in recurrent IgA nephropathy. Ann Intern Med 2003; 138:1011.
  42. Hotta K, Fukasawa Y, Akimoto M, et al. Tonsillectomy ameliorates histological damage of recurrent immunoglobulin A nephropathy after kidney transplantation. Nephrology (Carlton) 2013; 18:808.
  43. Kennoki T, Ishida H, Yamaguchi Y, Tanabe K. Proteinuria-reducing effects of tonsillectomy alone in IgA nephropathy recurring after kidney transplantation. Transplantation 2009; 88:935.
  44. Sato Y, Ishida H, Shimizu T, Tanabe K. Evaluation of tonsillectomy before kidney transplantation in patients with IgA nephropathy. Transpl Immunol 2014; 30:12.
  45. Briganti EM, Russ GR, McNeil JJ, et al. Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med 2002; 347:103.
  46. Choy BY, Chan TM, Lo SK, et al. Renal transplantation in patients with primary immunoglobulin A nephropathy. Nephrol Dial Transplant 2003; 18:2399.
  47. Sumethkul V, Jirasiritham S, Chalermsanyakorn P, Buranachokpaisan W. Chronic rejection: a significant predictor of poor outcome for recurrence IgA nephropathy. Transplant Proc 2001; 33:3375.
  48. Kimata N, Tanabe K, Ishikawa N, et al. Correlation between proteinuria and prognosis of transplant IgA nephropathy. Transplant Proc 1996; 28:1537.
  49. McDonald KJ, McMillan MA, Rodger RS, et al. Persistent dipstick haematuria following renal transplantation. Clin Transplant 2004; 18:321.
  50. Meulders Q, Pirson Y, Cosyns JP, et al. Course of Henoch-Schönlein nephritis after renal transplantation. Report on ten patients and review of the literature. Transplantation 1994; 58:1179.
  51. Han SS, Sun HK, Lee JP, et al. Outcome of renal allograft in patients with Henoch-Schönlein nephritis: single-center experience and systematic review. Transplantation 2010; 89:721.
  52. Thervet E, Aouizerate J, Noel LH, et al. Histologic recurrence of Henoch-Schonlein Purpura nephropathy after renal transplantation on routine allograft biopsy. Transplantation 2011; 92:907.
  53. Cronin CC, Feighery A, Ferriss JB, et al. High prevalence of celiac disease among patients with insulin-dependent (type I) diabetes mellitus. Am J Gastroenterol 1997; 92:2210.
  54. Newell GC. Cirrhotic glomerulonephritis: incidence, morphology, clinical features, and pathogenesis. Am J Kidney Dis 1987; 9:183.
  55. Pasternack A, Collin P, Mustonen J, et al. Glomerular IgA deposits in patients with celiac disease. Clin Nephrol 1990; 34:56.
  56. Amore A, Roccatello D, Picciotto G, et al. Processing of IgA aggregates in a rat model of chronic liver disease. Clin Immunol Immunopathol 1997; 84:107.
  57. Amore A, Coppo R, Roccatello D, et al. Experimental IgA nephropathy secondary to hepatocellular injury induced by dietary deficiencies and heavy alcohol intake. Lab Invest 1994; 70:68.
  58. Coppo R, Mazzucco G, Martina G, et al. Gluten-induced experimental IgA glomerulopathy. Lab Invest 1989; 60:499.
  59. Ghabra N, Piraino B, Greenberg A, Banner B. Resolution of cirrhotic glomerulonephritis following successful liver transplantation. Clin Nephrol 1991; 35:6.
  60. Woodrow G, Innes A, Boyd SM, Burden RP. A case of IgA nephropathy with coeliac disease responding to a gluten-free diet. Nephrol Dial Transplant 1993; 8:1382.
  61. Coppo R, Amore A, Roccatello D. Dietary antigens and primary immunoglobulin A nephropathy. J Am Soc Nephrol 1992; 2:S173.
  62. Rosenberg HG, Martínez PS, Vaccarezza AS, Martínez LV. Morphological findings in 70 kidneys of living donors for renal transplant. Pathol Res Pract 1990; 186:619.
  63. Suzuki K, Honda K, Tanabe K, et al. Incidence of latent mesangial IgA deposition in renal allograft donors in Japan. Kidney Int 2003; 63:2286.
  64. Ji S, Liu M, Chen J, et al. The fate of glomerular mesangial IgA deposition in the donated kidney after allograft transplantation. Clin Transplant 2004; 18:536.
  65. Sanfilippo F, Croker BP, Bollinger RR. Fate of four cadaveric donor renal allografts with mesangial IgA deposits. Transplantation 1982; 33:370.
  66. Koselj M, Rott T, Vizjak A, Kveder R. IgA nephropathy as a donor-transmitted disease in renal transplant recipients. Transplant Proc 1991; 23:2643.