Recurrence of Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Glomerulonephritis Following Kidney Transplantation: A Case Report With an Institutional Registry Review From Saudi Arabia

Background Recurrence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) following kidney transplantation is uncommon but may result in significant graft dysfunction and poor clinical outcomes. Data regarding recurrence after transplantation remains limited, particularly in the Middle East. Methods We present a case of early recurrent ANCA-associated glomerulonephritis following kidney transplantation, supported by a retrospective review of our institutional kidney transplant registry at King Fahad Specialist Hospital in Dammam, Saudi Arabia. Between 2008 and 2026, six patients underwent kidney transplantation for AAV-related end-stage kidney disease among 2306 kidney transplant recipients. Results Among 2306 kidney transplantations performed during the study period, six patients underwent transplantation for AAV-related end-stage kidney disease. Recurrence occurred in one patient (16.7%) and presented early in the post-transplant period with severe graft dysfunction. Histopathological evaluation demonstrated crescentic glomerulonephritis consistent with recurrent disease. Despite treatment with pulse corticosteroids and plasma exchange, the patient's clinical course was complicated by severe infectious complications resulting in death. The remaining five patients demonstrated generally favorable graft outcomes without evidence of recurrence during follow-up. Conclusion Recurrence of AAV after kidney transplantation remains uncommon. Although only one recurrence was identified in our cohort, the disease followed an aggressive clinical course in this patient, underscoring the importance of early recognition and prompt histological confirmation. Larger multicenter studies are needed to better define recurrence risk and optimize management strategies.