Chronic Allograft Nephropathy (Chronic Allograft Damage): Can It Be Avoided?

Although there has been significant progress over the last three decades in renal transplantation, which has been driven primarily by improvements in short-term graft survival, there has been little parallel improvement in long-term outcomes. Advances in histological indicators of chronic allograft pathology have the potential to allow for earlier intervention as well as to provide surrogate endpoints for drug development. Identification of risk factors such as the presence of acute rejection episodes, ischemia/reperfusion injury, donor and recipient age considerations, hypertension, hyperlipidemia, glomerular hyperfiltration, and cytomegalovirus infection will aid in the development of strategies and treatments to mitigate these risks. Of particular importance is the optimization of immunosuppressive regimens to prevent acute rejection episodes. Despite our deeper understanding of clinical risk factors, it is clear that other determinants of graft loss have yet to be identified and that other “missing” factors must play a role in the pathogenesis of late kidney graft loss, highlighting the need for effective therapies to rescue declining graft function.