Nephrol Dial Transplant (2002) 17: 1384-1390
© 2002 European Renal Association-European Dialysis and Transplant Association
Invited Comment
Chronic allograft failure: a disease we don't understand and can't cure?
Division of Nephrology, Department of Internal Medicine, Anichstrasse 35, A-6020 Innsbruck, Austria
Keywords: donor; kidney transplant; nephropathy; recipient
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During recent decades many new and successful strategies have been developed to improve 1-year renal allograft survival rates. It has become evident, however, that graft loss after the first year has not been reduced by the same magnitude. A high percentage of transplanted kidneys develop dysfunction in the first few months post-transplantation and ultimately fail, despite the use of modern immunosuppressive regimens. This type of graft failure has been termed chronic rejection. However, as both immune and non-immune mechanisms seem to contribute to its pathogenesis, the term currently used is chronic allograft nephropathy (CAN). The concept of chronic rejection slowly emerged in the 1950s and 1960s. Acute rejection was well known in the late 1950s, but even then only few kidneys survived for months. Initially Hume et al. [1], and later Porter et al. [2] and Jeannet et al. [3], reported arterial intimal
Recipient factors
Recipient age
Recipient blood pressure at time of transplantation
Recipient renal function status
Recipient sex, race, body mass index and native kidney disease
Number of previous transplants, pre-transplant pregnancies, pre-transplant transfusions and peak panel reactive antibodies
Donor factors
Donor age and donor type
Type of donor death and medical history of the donor
Combined recipient/donor factors
HLA matching
Organ preservation time
Delayed graft function
Acute rejection
Type of maintenance immunosuppression
Miscellaneous factors
Blood pressure post-transplantation
The search for a unifying hypothesis
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