Abstract: The recurrence of primary disease is an important cause affecting the short-term and long-term survival of transplant kidney, which receives increasing attention. Systemic disease-related renal damage may recur after kidney transplantation and cause varying degrees of damage to the transplant kidney. With an in-depth understanding of the pathogenesis of systemic disease-related renal damage, the level of diagnosis and treatment of recurrence of systemic disease-related renal damage in transplant kidney is gradually improving. Branch of Organ Transplantation of Chinese Medical Association organized organ transplantation experts to fully read, analyze, and summarize the current international and domestic literature. On the basis of "Technical Specification for Diagnosis and Treatment of Chronic Renal Allograft Dysfunction (2019 edition)", the risk factors, preventive measures, treatment measures, and prognosis of the recurrence of systemic disease-related renal damage were evaluated based on the Grading of Recommendations Assessment, Development and Evaluation for evidence quality and recommendation strength. The " Guidelines for Clinical Diagnosis and Treatment of Recurrence of Systemic Disease-Related Renal Damage in Transplant Kidney" were formulated, which provide recommendations for corresponding clinical issues to better ensure and promote the long-term survival of transplant kidneys and recipients.