With the incremental improvements in long-term kidney transplant survival, there is renewed
focus on what causes failure of the transplanted allograft. Over the past decade, our
understanding of the injuries that lead to loss of graft function over time has evolved. Chronic
allograft injury includes both immune-mediated and nonimmune-mediated injuries, which
may involve the organ donor, the recipient, or both. The targets of injury include the kidney
tubular epithelium, the endothelium, and the glomerulus. As a response to injury, there are …