title: Our evolving understanding of late kidney allograft failure.
abstract: OBJECTIVE
  Dramatic improvement in short-term results after kidney transplantation has fostered a change in focus for clinical research: further improvement in patient outcomes requires better understanding of late allograft failure.
  
  
  RESULTS
  As recently as a decade ago, with clinicians and investigators besot by the mistaken assumption that 'rejection' was under control, most late allograft failure was attributed to calcineurin inhibitor nephrotoxicity. Application of newer laboratory-based techniques (C4d staining, solid-phase antibody assays, and molecular profiling) has resulted in a major shift in understanding late graft failure. New data from both clinic and laboratory indicate immunologic injury, perhaps potentiated by drug minimization, as the predominant cause of late allograft failure.
  
  
  CONCLUSIONS
  This review traces our evolving understanding of the problem and what looks to be a paradigm change that offers new promise of effective intervention to improve long-term outcomes.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. rgaston@uab.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Gaston
mesh_terms: D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000009:adverse effects; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000276:immunology*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine