title: Chronic allograft injury: Mechanisms and potential treatment targets.
abstract: Improving long-term graft survival remains one of the critical challenges facing kidney transplantation since a great portion of kidney grafts are lost by 10years after transplantation. Understanding the causes of chronic allograft injury and providing timely therapeutic interventions are essential for improving these outcomes. In this review, we will discuss the recent data that emerged turning down calcineurin inhibitors as the primary cause of long-term graft injury and highlighting the increased importance of non-compliance, antibody-mediated injury, disease recurrence, and BK nephropathy as culprits. We suggest a number of different strategies to better manage kidney transplant recipients that, ultimately, may improve long-term graft survival.
authors.affiliation: Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: lriella@bwh.harvard.edu.
authors.forename: Leonardo V
authors.initials: LV
authors.lastname: Riella
authors.affiliation: Renal Division, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
authors.affiliation: Servicio de Nefrología, Hospital del Mar, Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
mesh_terms: D064591:Allografts; D001707:Biopsy, Needle; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D018570:Risk Assessment; D013997:Time Factors; D014019:Tissue Donors; D014181:Transplantation Immunology / Q000187:drug effects*; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents