Abstract: FR-PO1161
Sparsentan for Recurrent IgAN After Kidney Transplantation
Session Information
- Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Afzal, Aurangzeb, Virginia Commonwealth University, Richmond, Virginia, United States
- Hartle, Matthew, Richmond Nephrology Associate, Richmond, Virginia, United States
- Muthusamy, Selvaraj, Virginia Commonwealth University, Richmond, Virginia, United States
- Kidd, Jason M., Virginia Commonwealth University, Richmond, Virginia, United States
Introduction
Recurrent IgA nephropathy (IgAN) is a major cause of allograft failure. With the development of novel treatments for IgA nephropathy, new approaches are possible for the management of post-transplant recurrence, but studies are limited. We present a case of sparsentan use for recurrent IgA nephropathy.
Case Description
A 62-year-old male, eight years after living unrelated donor kidney transplantation for IgAN, presented with new-onset proteinuria and microscopic hematuria. Serum creatinine was 0.82 mg/dL, and urine albumin-to-creatinine ratio was 1325 mg/g. Urinalysis was significant for 5-10 red blood cells per high-power field. Tacrolimus trough was 3.9 ng/mL. He had no prior history of rejection. Polyomavirus PCR, hepatitis B serologies, and hepatitis C RNA were negative. Allograft biopsy showed diffuse mesangial expansion and hypercellularity with 33% global glomerulosclerosis, mild tubular atrophy and interstitial fibrosis, and mild arteriolar hyalinosis. Immunofluorescence demonstrated dominant IgA (4+) and C3 (3+) mesangial staining with negative IgG, C1q, and C4d. Banff scores excluded rejection. A diagnosis of recurrent IgA nephropathy was made. Oxford MEST-C scores were M1 E0 S0 T1 C0. Losartan was discontinued and sparsentan was initiated. Tacrolimus dose was increased to 2 mg twice daily. One month after starting sparsentan, urine albumin-to-creatinine ratio decreased to 178 mg/g, renal function was stable and liver enzyme testing was unremarkable.
Discussion
Sparsentan provides dual endothelin and angiotensin receptor blockade and reduces proteinuria in patients with IgA nephropathy. This case supports further investigation into the use of sparsentan as a targeted antiproteinuric strategy in recurrent IgAN post-transplant. Key considerations include monitoring drug-induced hepatotoxicity, and potential pharmacokinetic interactions with tacrolimus via shared CYP3A4 metabolism. Further study is required.