Abstract: FR-OR067
Natural History of Recurrent IgAN After Kidney Transplantation: Findings from the UK National Registry of Rare Kidney Diseases (RaDaR)
Session Information
- New IgAN Therapies: Subgroups, Outcomes, and Biomarkers
October 23, 2026 | Location: Room 501, Convention Center
Abstract Time: 05:00 PM - 05:10 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Masoud, Sherry, UK National Registry of Rare Kidney Diseases (RaDaR), Bristol, United Kingdom
- Ralph, Vivienne, King's College London, London, England, United Kingdom
- Sorrell, Lexy, UK National Registry of Rare Kidney Diseases (RaDaR), Bristol, United Kingdom
- Pitcher, David, UK National Registry of Rare Kidney Diseases (RaDaR), Bristol, United Kingdom
- Mercer, Alex, JAMCO Pharma Consulting, Stockholm, Sweden
- Hendry, Bruce, Travere Therapeutics, Inc., San Diego, California, United States
- Shah, Sapna, King's College London, London, England, United Kingdom
- Roberts, Ian, Oxford University Hospitals NHS Foundation Trust, Oxford, England, United Kingdom
- Barratt, Jonathan, University of Leicester, Leicester, England, United Kingdom
- Gale, Daniel P., UK National Registry of Rare Kidney Diseases (RaDaR), Bristol, United Kingdom
Background
IgA nephropathy (IgAN) carries a high lifetime risk of kidney failure (KF); transplantation is the preferred treatment but can be complicated by recurrent IgAN (rIgA). In an evolving therapeutic landscape, detailed characterisation of rIgA and its impact on graft outcomes is needed. We address this using longitudinal data from the UK National Registry of Rare Kidney Diseases (RaDaR).
Methods
1411 first transplant recipients (2000-2025) with primary IgAN from 37 centres were included. rIgA was defined by for-cause biopsy and/or record of rIgA in clinical notes. Cumulative incidence of 1st event (rIgA; graft failure [KF or sustained eGFR <15]; or death) was estimated overall and stratified by age at transplantation. Associations with rIgA from 1 year post transplant were estimated using adjusted Fine–Gray models (competing risks: death & graft failure). Cox PH analyses of graft loss (composite of graft failure & death) used mutually exclusive time-varying covariates for 1) rIgA 2) rIgA with rejection (concurrent/subsequent), with forward transition between states over follow-up.
Results
245/1411 had rIgA detected. Cumulative incidence at 15 years was 24% (95%CI 21-27) overall, 32% (95%CI 27–37) for age <40 years at transplantation and 18% (95%CI 15-22) for age ≥40; first events are shown in Figure 1. Risk factors for rIgA included younger age at transplant (sHR 1.36 per 10 years; 95%CI 1.20-1.53) and no prednisolone at 1 year (sHR 1.59; 95%CI 1.17-2.16). Over median follow-up of 9.1 years (IQR 4.5–14.7), 377/1411 (27%) patients experienced graft loss. rIgA without rejection was associated with an increased risk of graft failure/death (HR 5.57, 95%CI 4.37–7.11); among all rIgA 5-year graft loss was 53% (95%CI 46-60).
Conclusion
Recurrent IgAN disproportionately affected younger recipients, potentially reflecting more aggressive underlying disease, and was associated with a five-fold increased risk of graft loss. This association and its temporal relationships are being further explored. The magnitude of the association suggests an important unmet need in this population.
Funding
- Commercial Support – Travere Therapeutics provided funding support for the analysis