Prevention and management of late renal allograft dysfunction.

Chronic allograft nephropathy is the leading cause of return to dialysis after transplantation. At present, no efficient therapies are available to modify the natural history of chronic allograft nephropathy, mainly because of difficulties in designing prospective clinical trials to prevent or treat this entity. The main risk factors for chronic allograft nephropathy, the utility of protocol biopsies in the design of trials, and different strategies to prevent or treat this problem are reviewed.