Chronic renal allograft loss.

The phenomenon of late renal allograft loss accounts for 80% of the patients listed as returning to end-stage renal disease after kidney transplantation. This recidivism problem, which is seen as an inexorable decline in actuarial graft survival following the first year after transplantation, has a number of causes. There is good evidence that both immunologic and nonimmunologic factors are important in late graft loss. Newer DNA-based methods for histocompatibility testing permit more accurate assessment of risk for ultimate graft survival. Nonimmunologic risk factors for chronic graft dysfunction and failure may include donor kidney size that is inadequate for the demands made be the recipient. Distinction should be made between the phenomenon of late acute graft loss due to noncompliance and true chronic renal transplant failure. Patient death is a significant confounding variable, which substantially changes interpretation of chronic graft loss associated with conditions that increase patient morbidity and mortality. Prospective multivariant studies of risk factors and intervention strategies for chronic allograft are in order.