The kidney transplant: new horizons

In renal transplantation, significant improvements in short-term allograft survival have been accomplished, but do not translate into comparable extension of long-term function. Thus, late allograft failure is the challenge while the underlying disease processes are mostly elusive. The purpose of this review is to summarize new diagnostic insights into the identification of specific causes of late allograft failure.

In 2005, the Banff working group for allograft pathology eliminated the term 'chronic allograft nephropathy'. This became necessary due to the fact that this generic term, summarizing all disease processes causing chronic allograft damage, mutated in the literature into an entity explaining most kidney allograft failures. Since 2005, pathologists have been urged to assign a specific diagnosis instead of using the nonspecific term chronic allograft nephropathy. Simultaneously, considerable research efforts (i.e. the Genome Canada Project and Deterioration of Kidney Allograft Function study) were implemented to identify specific causes of renal allograft failure. In 2009, results from these initiatives were presented indicating that antibody-mediated rejection and recurrent/de-novo glomerulonephritis are the major causes of late renal allograft failure.

With new diagnostic tools available, a disease-specific approach in renal allograft damage becomes feasible. This will allow for designing entity-specific trials and establishment of specific treatments, eventually improving long-term allograft function.