Mechanisms of Podocyte Injury in Kidney Allografts

Long-term kidney allograft survival remains an important clinical challenge. Although immune-mediated injury, particularly antibody mediated rejection, is associated with long-term graft loss, nonimmune mechanisms also drive chronic allograft failure. Podocytes are essential components of the glomerular filtration barrier, and their injury in the transplant setting may accelerate graft loss. In this review, we will discuss mechanisms of podocyte injury contributing to chronic graft failure including immune injury and nonimmune mechanisms such as immunosuppressive drug exposure and transplant-specific biomechanical changes.