Chronic allograft nephropathy.
OBJECTIVE
Despite dramatic declines in acute rejection and early graft failure, long-term outcomes after kidney transplantation have improved little during the past 25 years. Most late allograft failure is attributed to chronic allograft nephropathy, but this is a clinicopathological description and not a diagnosis, and its pathogenesis and treatment are largely unknown.


RESULTS
Recent studies suggest that acute rejection during the first few months, and calcineurin inhibitor toxicity thereafter, may both contribute to chronic allograft nephropathy. There is also accumulating evidence that injury from antibody-mediated rejection may play an important pathogenic role in at least some patients with chronic allograft nephropathy, particularly those with transplant glomerulopathy. Therapeutic measures, including protocols to reduce calcineurin inhibitor exposure, remain largely unproven.


CONCLUSIONS
Understanding why so many kidney allografts fail, despite effective preventive measures for early acute rejection, is one of the most important areas of research in kidney transplantation today.
Najafian
Behzad
B
Department of Laboratory Medicine and Pathology, University of Minnesota, USA.
Kasiske
Bertram L
BL
D000208:Acute Disease; D000818:Animals; D001323:Autoantibodies / Q000097:blood; D065095:Calcineurin Inhibitors; D002908:Chronic Disease; D050533:Glomerular Basement Membrane / Q000473:pathology; D006084:Graft Rejection / Q000150:complications / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007674:Kidney Diseases / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D001323:Autoantibodies; D065095:Calcineurin Inhibitors; D006680:HLA Antigens; D007166:Immunosuppressive Agents