Chronic rejection of renal transplants: New clinical insights

Chronic rejection is the most important cause for returning to dialysis aft er failure of a renal transplant. The term chronic allograft nephropathy re fers to the progressive decline of renal function seen in some renal transp lant recipients in association with alloantigen-dependent and alloantigen-i ndependent factors. This review examines the role of factors related to all orecognition, injury, nephron dosing, and donor and recipient characteristi cs in the development of chronic allograft nephropathy. The clinical associ ations to chronic allograft nephropathy are presented in the context of pat hogenetic mechanisms of renal damage and disease progression. As there is n o therapy available at this time for established chronic allograft nephropa thy, possible areas of intervention for the prevention of chronic rejection are discussed.