Kidney transplantation is currently the definitive treatment for patients with end-stage kidney disease (ESKD). Compared to dialysis, kidney transplantation is associated with reduced mortality and improved quality of life. Rejection of the kidney is one of the leading causes of allograft loss. Other causes of kidney allograft loss include recurrent glomerular disease, fibrosis, calcineurin-inhibitor (CNI) toxicity, and BK virus-associated nephropathy. Kidney allograft rejection can subdivide into hyperacute, accelerated, acute, and chronic rejection. Chronic kidney transplant rejection (CKTR) refers to graft failure and rejection beyond 1-year post-transplant, in the absence of acute rejection, drug toxicity (particularly CNIs), and other causes of nephropathy. Chronic kidney injury after transplantation was previously often labeled as “chronic allograft nephropathy,” a term that has fallen out of favor, replaced by biopsy-specific findings that may point to chronic immune injury or display interstitial fibrosis and tubular atrophy (IFTA) which are non-specific findings.
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