Chronic allograft rejection: an update

The aetiology of chronic rejection is most likely multifactorial. The common feature in all organ allografts undergoing chronic rejection is persistent perivascular inflammation and a concentric generalised arteriosclerosis affecting all first and second order intramural arteries. A hypothesis is presented that low-grade damage to the endothelium induces the secretion of growth factors which, in turn, are responsible for smooth muscle cell replication and their influx into intima.