CHRONIC RENAL-ALLOGRAFT FAILURE - CLINICAL OVERVIEW

The factors that have led to a steady improvement of one-year renal al lograft survival, have not resulted in better long-term outcome. Main causes of chronic renal allograft failure are patient death with a fun ctioning transplant, chronic rejection and non-compliance with immunos uppressive therapy. The role of hyperfiltration as a cause of graft fa ilure is at present unclear. Among the risk factors associated with al lograft outcome are donor- and recipient characteristics, HLA matching , delayed graft function and acute rejection episodes. As with short-t erm results there are considerable differences between transplant cent ers. The effect of cyclosporine-based immunosuppression on late graft outcome is still controversial. Possibly, the potential benefit of cyc losporine is obscured due to suboptimal dosing in the fear of chronic nephrotoxicity.