Chronic allograft nephropathy: The major problem in long-term survival: Review of etiology and interpretation

Kidney transplantation (Tx) has evolved as the treatment of choice in patients with end-stage renal failure. Unfortunately, after Tx, there is a gradual deterioration in graft function and the patient develops chronic allograft nephropathy (CAN). This can happen as soon as 3 months or as late as many years. Therefore, CAN is the major clinical problem in renal Tx, as the pathophysiological mechanisms remain obscure. In this article, we try to review the risk factors and causes of CAN and their possible explanation. In conclusion, and as a consequence from the bibliography, we can see clearly that CAN is the result of interplay or synergistic action between alloantigen-dependent and alloantigen-independent factors, which each act with different significance at each stage in the life span of a transplant. The exactly pathogenesis of CAN is elusive but we have a common trigger (tissue injury) and common response (inflammatory response).