Management strategies for post-transplant IgA nephropathy in kidney transplant recipients: a scoping review
Abstract
Background: Post-transplant Immunoglobulin A Nephropathy (IgAN) is an important cause of premature graft loss. Management strategies are often extrapolated from native IgAN, with available evidence limited to heterogeneous, predominantly small retrospective studies.
Objectives: To characterise diagnostic criteria, map management strategies, and summarise associated clinical outcomes in post-transplant IgAN.
Methods: A literature search was performed in MEDLINE, Embase, Web of Science, and Scopus (1st January 2000-11th December 2025) following Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines. English-language studies of adult kidney transplant recipients with biopsy-proven post-transplant IgAN and documented management strategies were included. Data on study design, cohorts, diagnostic criteria, interventions, and outcomes were charted and narratively described.
Results: Twenty-seven studies met the inclusion criteria. Most were single-centre retrospective cohorts. Diagnostic criteria varied, but typically histological evidence of IgA deposition alone was sufficient. IgAN was often clinically relevant, with proteinuria > 1 g/day frequently reported. Reported treatments included renin-angiotensin-aldosterone system (RAAS)-blockade, immunosuppression adjustment, rituximab, tonsillectomy and pulsed corticosteroids. Several small case series explored emerging therapies (iptacopan, budesonide, telitacicept). Study heterogeneity precluded quantitative data synthesis.…
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