Causes of late renal allograft loss: chronic allograft dysfunction, death, and other factors.

CAN and patient death with allograft function are the 2 major causes of renal allograft loss after the first year, accounting for 80% or more of cases. According to current estimates from the United Network for Organ Sharing (UNOS), the half-lives for renal allografts performed in 1995 and 1996 from living and cadaveric donors are 15.3 and 10.4 years, respectively (2). Consequently, much attention has been focused on better understanding the causes of CAN and patient death with a functioning allograft in an attempt to improve long-term renal allograft outcomes. Although the pathogenesis of CAN is not completely understood, we know that CAN involves alloantigen-dependent and alloantigen-independent factors that combine to produce chronic deterioration of renal allograft function. CVD is the most frequent cause of death in renal transplant recipients, and we need to address its well-established risk factors in that population. Among other improvements, changes in current immunosuppressive protocols may increase long-term renal allograft survival and function by decreasing both the risk of CAN and the risk of CVD.