Abstract
Chronic renal allograft disease remains a leading cause of graft loss. Immunologic and non-immunologic risk factors are related to its development and may be present before or develop after transplantation. Histological evaluation of renal tissue has an important role in the management, especially for the evaluation of immune activity against the graft and toxicity of immunosuppressive drugs. Management of this condition is generally restricted to changes in the immunosuppressive regimen and the overall control of conditions related to the progression of chronic kidney disease.
Highlights
Significant advances in immunosuppressive therapy, mainly in the two last decades, have importantly reduced the rate of acute rejection and substantially increased short-term patient and graft survival in renal transplant recipients
The expression interstitial fibrosis and tubular atrophy (IF-TA) is used to describe conditions in which fibrosis and atrophy develop in the absence of defined etiologic factors, the term chronic allograft nephropathy (CAN) having been removed from pathology classification
Because BP is a modifiable risk factor for graft loss, the same authors tested the impact of BP control on this outcome, having found that reduction of the systolic blood pressure (SBP) is associated with better graft survival indices.[28]
Summary
Significant advances in immunosuppressive therapy, mainly in the two last decades, have importantly reduced the rate of acute rejection and substantially increased short-term patient and graft survival in renal transplant recipients. Histologic findings are present in most grafts few years posttransplantation, and are practically universal after ten years.[4] The condition initially termed chronic allograft nephropathy (CAN) led to considerable confusion regarding the understanding and. The expression interstitial fibrosis and tubular atrophy (IF-TA) is used to describe conditions in which fibrosis and atrophy develop in the absence of defined etiologic factors, the term chronic allograft nephropathy (CAN) having been removed from pathology classification. 6 On the other hand, the term chronic allograt nephropathy (CAN) remains in widespread use in the clinical setting, to refer to a chronic, progressive disease of the kidney graft, of undetermined etiology, and generally with an onset within three months posttransplantation. I will use the term chronic renal allograft disease (CRAD) instead of chronic allograft nephropathy (CAN), as the latter tends to be abandoned.
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