Call for Revolution: A New Approach to Describing Allograft Deterioration

Abstract

I propose a set of definable entities in the renal transplant course, eliminating the need for the term 'chronic rejection'. The status of a renal transplant can be defined by the presence and extent of rejection (T-cell-mediated or antibody-mediated); allograft nephropathy (parenchymal atrophy, fibrosis, and fibrous intimal thickening in arteries); transplant glomerulopathy; specific diseases; and factors which could accelerate progression. The level of function and the slope of the loss of function should be separately determined. This approach can be applied both in research and in clinical practice, and can be adapted to other organ transplants.

The Burden of Chronic Kidney Disease in Renal Transplant Recipients

“…The pathologic features of allograft nephropathy are highly prevalent in renal transplant recipients and have been associated with immune and nonimmune factors (23). The potential for ongoing immune injury suggests that CKD in transplant recipients may be different from most forms of nontransplant CKD.…”

Histopathologic Findings and Classification of Feline Renal Transplants

“…3,25 This is an interesting observation because antibody-mediated rejection is increasingly considered to be an important cause for ongoing renal allograft damage in humans. 9,17 It should be kept in mind that all cats were treated with cyclosporine, a potential nephrotoxin. 19,31 Cyclosporine intoxication in the form of isomorphometric tubular vacuolization 19 was found in a fair number of cats.…”

Transplantation of the Intestine: Is it Truly Different?

“…The findings of Ruiz et al demonstrate how a policy of frequent allograft biopsy (the authors performed 188 biopsies in 21 patients within 3 months of transplantation) may provide new insights into the mechanisms of allograft damage following transplantation. The role of allograft biopsy has recently been emphasized in an editorial by Dr Phillip Halloran in which he discussed the etiology, evaluation, and treatment of chronic allograft nephropathy (10). I agree with Dr Halloran that allograft biopsy is a critical tool that offers great opportunity for developing a fuller understanding of the immune and nonimmune mechanisms that contribute to allograft damage.…”