chronic rejection

In recent years, acute rejection has been significantly controlled by immunosuppressive therapy, and chronic rejection has emerged as an important cause of graft failure.

Patients with chronic rejection present clinically with a progressive rise in serum creatinine over a period of 4 to 6 months.

Chronic rejection is dominated by vascular changes, interstitial fibrosis, and tubular atrophy with loss of renal parenchyma. The vascular changes consist of dense, obliterative intimal fibrosis, principally in the cortical arteries.

These vascular lesions result in renal ischemia, manifested by glomerular loss, interstitial fibrosis and tubular atrophy, and shrinkage of the renal parenchyma.

The glomeruli may show duplication of basement membranes; this appearance is sometimes called chronic transplant glomerulopathy. Chronically rejecting kidneys usually have interstitial mononuclear cell infiltrates containing large numbers of plasma cells and numerous eosinophils.