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.