*Purpose: Recurrence of IgA nephropathy (IgAN) is one of the major cause of kidney graft loss. The clinical features of disease recurrence after kidney transplantation (KT) and the effect of maintenance steroid against disease recurrence had not been thoroughly understood.

*Methods: Among the 558 kidney recipients in Hokkaido University and Sapporo City General Hospital, 90 patients whose original disease was biopsy proven IgAN [48 male/42 female, median age at KT 42 (13-69) years old, living donor 82/deceased donor 8, observation period after transplantation: median 8.1 (0.27-14.3) years] were enrolled. They were maintained with a calcineurin inhibitor and mycofenolate mofetil. Sixty patients used continuous steroid (continuous steroid group, CS) and the other 30 patients discontinued steroid at POD3 (steroid withdrawal group, SW). Nine patients performed tonsillectomy before KT. We surveyed the post-transplant recurrence rate and the clinical manifestation of IgAN, treatment, outcomes and compared them between two groups.

*Results: Twenty among 90 patients in total(22.2%)showed histological IgAN recurrence [recurrence period:median 403(96−2021)days]. There was no significant difference in recurrence rate between two groups {14 patients (23.3%) in CS, 6 patients (20%) in SW}. Interestingly, no recurrence was observed among 9 patients who had tonsillectomy before KT. The cause of diagnosis was proteinuria (urinary protein UTP≧0.3 g/gCre) in 11 patient (55%). Among the 11 UTP positive patients, 2 patients had 20% elevation of serum creatinine (SCre), 1 patient had microhematuria and 1 patient had macrohematuria. In 9 patients (45%), IgAN recurrence was pointed out according to protocol biopsy with no clinical abnormality. Median SCre and median UTP at recurrence were 1.46 (0.5-2.42) mg/dl and 0.99 (0.03-1.95) g/gCre, respectively. Treatment for recurrence was steroid pulse (SP) alone in 1 patient, tonsillectomy alone in 8 patients, SP + tonsillectomy in 10 patients, no treatment in 1 patient, respectively. Of these, one patient lost his graft.

*Conclusions: There was no preventive effect of continuous steroid exposure against disease recurrence. Unlike native IgAN, proteinuria was major symptom of IgAN recurrence in kidney allograft. Furthermore, since half of patients did not have any symptom, protocol biopsy is valid for the early diagnosis of IgAN recurrence.

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