*Purpose: An additional investigation on the clinical significance of the updated Oxford classification in allograft IgA nephropathy (IgAN) is warranted.

*Methods: We performed a retrospective cohort study at two tertiary hospitals. Kidney transplant recipients diagnosed for allograft IgAN with pathologic slides with sufficient quality for additional review by specialized pathologists were included in the study. We applied the updated Oxford classification and scored the MEST-C. The main study outcome was death-censored graft failure (DCGF) within 10 years since the establishment of allograft IgAN diagnosis and was assessed using Cox regression analysis.

*Results: A total of 333 allograft IgAN patients were reviewed, and 232 patients had at least one component of the Oxford classification. With a median follow-up duration of 4.0 years, 88 patients progressed to DCGF. All MEST-C score components were associated with an increased risk of DCGF when adjusted for age, sex, estimated glomerular filtration rate, graft age, presence of coexisting rejection, usage of tacrolimus, and renin-angiotensin-aldosterone system blockades. Higher total MEST-C sum scores were associated with higher risk of DCGF, and the risk significantly increased with sum score ≥2 (adjusted hazard ratio, 2.260 [1.347-3.791]).

*Conclusions: Therefore, the Oxford classification may be reported in allograft IgAN patients. Total MEST-C sum score may be a comprehensible predictive parameter for DCGF in post-transplant IgAN.

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