Long-term effects of nonimmune tissue injury in renal transplantation

The successful kidney transplant must withstand the stresses of the transplant process and the posttransplant course and maintain itself over many years. Allograft nephropathy is the pathology most frequently associated with late renal graft loss. Allograft nephropathy is defined by graft dysfunction and a characteristic but unspecific pathology, with tubular atrophy, interstitial fibrosis, and fibrous intimal thickening of blood vessels. A number of early factors lead to the development of allograft nephropathy—older donor age, brain death, prolonged preservation time, and rejection—but drug toxicity, hypertension, and other recipient factors can contribute as time passes. Allograft nephropathy is the result of these cumulative injuries plus the inherent ability of the kidney to resist and repair injury. This overview highlights some nonimmunologic injuries important in the course of transplantation and in the evolution of allograft nephropathy.