| Theme |
Necessary kidney transplant knowledge for the dialysis staff, 2013 |
| Title |
Chronic rejection |
| Author |
Keiji Horike |
Department of Nephrology, Nagoya Daini Red Cross Hospital |
| Author |
Asami Takeda |
Department of Nephrology, Nagoya Daini Red Cross Hospital |
| Author |
Kunio Morozumi |
Department of Nephrology, Nagoya Daini Red Cross Hospital |
| [ Summary ] |
Chronic rejection/chronic allograft nephropathy (CAN) is characterized by a slow progressive deterioration of graft function, often in combination with proteinuria and hypertension. Both immunologic and non-immunologic factors play key roles in the pathogenesis of chronic allograft nephropathy. Many risk factors for CAN have been identified, such as delayed graft function, nephron-dosing mismatch, repeated acute rejection episodes, and pathologically severe rejection. However, the precise pathogenesis of CAN remains elusive. The term "CAN" may be clinically preferable to "chronic rejection" to describe the gradual decline in graft function months or years after transplantation, in the absence of a well defined mechanism of graft dysfunction. Recently, chronic active antibody-mediated rejection (CAAMR) has been recognized as a narrowly defined form of chronic rejection. CAAMR is an important cause of chronic allograft dysfunction and graft loss. CAAMR is characterized by pathological findings and the presence of circulating anti-donor antibodies. The most effective way to prevent CAN is to avoid any kind of graft damage via either immunologic or non-immunologic mechanisms. However the pathogenesis of chronic graft dysfunction is complex. Chronic rejection will be elucidated in the future due to progress in immunological analysis and progress in pathological diagnostic criteria development, related to the diagnosis of non-immunological organ failure. |