#2606 Recurrence of IgA nephropathy in a large multicenter cohort of kidney transplant recipients (DIVAT)

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Abstract Background and Aims IgA nephropathy (IgAN) can recur after transplantation. However, the frequency of relapse, its risk factor and outcome are still poorly understood. Method We studied this parameter in a large multicentre cohort of consecutive patients transplanted between 2005 and 2023 in 7 French hospitals belonging to the Données Informatisées VAlidées Transplantation (DIVAT) database. Results Clinical recurrence of IgAN (diagnosed by biopsy made for cause) was reported in 147 out of 1347 patients (10.9%). Three, five- and ten-years cumulative incidence was of 5.4% [4.0; 6.7], 9.2% [7.3; 11.0] and 16.3% [13.5; 19.1] respectively. Multivariable Cox regression showed a higher risk for recurrence in younger patients (HR 0.96 [0.95; 0.98], for each year) and for patients with de novo DSA (HR 2.27 [1.50; 3.44]. Neither pre-emptive status nor steroid use was associated with recurrence. Graft loss was higher in patients with recurrence of IgA (HR 1.89 [1.51; 2.35]). Conclusion In a large cohort of kidney transplant recipients, recurrence of IgAN after kidney transplantation is a frequent event that greatly impacts graft survival. Further analysis is needed to clarify whether the association of recurrence with DSA de novo is causal or due to a detection bias.

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