Incidence and Causes of Long-term Renal Allograft Loss

The dramatic improvement observed in the short term of graft survival following the introduction of cyclosporine A, led many transplant doctors to think that long term patient and graft survival will also show similar improvement. This has not been the case and after the first year, the survival curves run parallel to those observed during the earlier years. In an analysis of 446 patients whose grafts functioned for more than 1 year, chronic rejection alone accounted for more than 80% cases of graft loss among the 53 cases with progressive graft failure. Previous acute rejection was found to be an important predisposing factor to chronic rejection in these cases. Since chronic rejection is still an untreatable condition, all efforts should be made to prevent acute rejection in the hope that this may lessen the likelihood of late graft failure.