Improving long-term graft survival as a means to reduce retransplantation.

Long-term follow-up studies of renal transplant patients have shown that chronic rejection is the single most prevalent cause of graft failure after the first post-transplant year [1]. It is not known how many of these patients will undergo retransplantation but data from our own institution suggest that 60-70% of retransplants lost a previous graft due to chronic rejection. There are no large registry data available to directly confirm this impression but of the more than 14000 second cadaver kidney transplants reported to the Collaborative Transplant Study Registry, 57% had a previous graft that had lasted for more than 6 months and 49% had a previous graft that had lasted for more than 1 year. As chronic rejection is the single most important cause of graft failure in this time frame, it would seem that avoidance of chronic rejection will reduce the need for retransplantation. The aim of the current review is to evaluate the risk factors of chronic rejection and to suggest strategies to decrease its prevalence. [ABSTRACT FROM AUTHOR]