Chronic Renal Allograft Dysfunction

Chronic allograft nephropathy (CAN) and death with graft function have been the leading causes of late kidney graft loss in the last 20 years. The term CAN substituted the old term “chronic allograft rejection” and designs a poorly understood condition characterized by a progressive decline of graft function often associated with hypertension and proteinuria and non-specific histologic changes affecting all kidney compartments. As CAN includes many specific chronic diseases caused by different etiopathogenic mechanisms, workers attending the 8^th Banff Conference on Allograft Nephropathy decided to eliminate and to replace the term CAN by “interstitial fibrosis and tubular atrophy without evidence of any specific etiology”. The implications of this change in the future could probably be of paramount importance and contribute to a better understanding and treatment of the different entities included in the term CAN. In the present chapter, the different conditions associated with a progressive decline of graft function such as interstitial fibrosis and tubular atrophy, transplant glomerulopathy, chronic T-cell mediated rejection and calcineurin inhibitor toxicity are described, with special emphasis on the clinical course, the possible etiopathogenic mechanism, the diagnostic criteria and the different therapeutical options.

Keywords: Kidney Transplantation, Graft Dysfunction, Immunosuppression, Chronic Allograft Vasculopathy, Interstitial Fibrosis, Tubular Atrophy, Transplant Glomeruolpathy, Calcineurin Inhibitors, Calcineurin Toxicity, Kidney Biopsy.