<p><b><i>Background:</i></b> Most studies that have assessed the
predictors of recurrent IgA nephropathy (IgAN) in the renal allograft
have focused on post-transplant features. Identifying high-risk
pre-transplant features of IgAN is useful for counseling patients and
may help in tailoring post-transplant immunosuppression. <b><i>Methods:</i></b>
We investigated the pre-transplant clinical and biopsy features of 62
patients with IgAN who received transplants at Columbia University
Medical Center from 2001 to 2012 and compared the characteristics and
outcomes of patients with IgAN recurrence to those without recurrence.
The primary outcome was time to recurrent IgAN. Secondary outcomes were a
composite of doubling of creatinine or allograft failure, and recurrent
IgAN as a cause of allograft dysfunction. <b><i>Results:</i></b> Of the
62 patients, 14 had recurrent IgAN in the allograft. Mean time to
recurrence was 2.75 years. Those with recurrent disease were younger at
the time of native kidney biopsy (29 vs. 41 years, p < 0.0009). Black
race and Hispanic ethnicity composed a higher proportion of the
recurrent disease group. On multivariable analysis, significant
predictors of recurrent IgAN included age at diagnosis (hazards ratio
(HR) 0.911, 95% CI 0.85-0.98), burden of crescents on native biopsy (HR
1.21 per 10% increase in crescents, 95% CI 1.00-1.47) and allograft
rejection (HR 3.59, 95% CI 1.10-11.7). <b><i>Conclusions:</i></b>
Features of native IgAN can help predict the risk of recurrent disease
in the renal allograft. In particular, immunologically active disease
represented by earlier age of onset and greater burden of crescents on
native biopsy is more likely to recur after transplant.</p