The aim of this work was to study the operational performance and the microbial community dynamics during the start-up of ANITATMMox technology implemented at full-scale wastewater treatment plant in Finland to treat reject water from anaerobic digesters. The average ammonium removal in the studied setup reached around 90%, withstanding ammonium loads up to 0.13 g N m-2h-1. The nitrite concentration in the effluent did not exceed 10 mg L-1, and there was a slight accumulation of NO3--N during the operation which was controlled. Thus, the result showed a robust success to high ammonium loading in presence of organic matter. The sequencing showed a heterogeneous microbial population where Methanosaeta, WCHA1-57 genus, Sphingobacteriia, Chlorobia and diverse unknown fungi were found as dominant phylotypes. Moreover, members of the Brocadiaceae family were dominant in the adhered biomass, mostly represented by Candidatus Scalindua, rarely reported in WWTPs. Overall, the results demonstrated a drastic effect of region-specific operational conditions on carrier biofilm microbial communities as it was demonstrated by the microbial studies.