Pediatric Nephrology

, Volume 22, Issue 1, pp 17–23

Chronic allograft nephropathy in paediatric renal transplantation

  • Stephen I. Alexander
  • Jeffrey T. Fletcher
  • Brian Nankivell
Review
  • 117 Downloads

Abstract

Chronic allograft nephropathy (CAN) is now the leading cause of renal transplant loss in paediatric transplant recipients. Despite improvements in immunosuppression, which have significantly reduced the incidence of acute rejection, the rates of chronic kidney loss have remained unchanged in paediatric transplant patients over the last 20 years. Chronic allograft nephropathy is a pathological diagnosis of which the key features are tubular atrophy and interstitial fibrosis. More consistent definitions and grading of these through the Banff classification have allowed more rigorous study of the development of chronic allograft nephropathy along with further identification of specific lesions associated with the underlying aetiologies. While initially thought to be primarily due to immune injury, it is now evident that CAN is the end result of a variety of immune and non-immune injuries including ischaemia reperfusion injury, calcineurin inhibitor (CNI) toxicity and infections. Protocol biopsy studies have demonstrated rates of CAN development in children similar to those in adults with comparable underlying pathological processes. This review outlines the current knowledge of CAN within the context of paediatric renal transplantation.

Keywords

CAN CNI Transplantation Kidney Protocol biopsy 

Abbreviations

CAN

Chronic allograft nephropathy

SCR

Subclinical rejection

CNI

Calcineurin inhibitors

CADI

Chronic Allograft Damage Index

CCTT

Cooperative Clinical Trials in Transplantation

PAS

Periodic Acid Schiff

ACR

Acute cellular rejection

TGF-β

Tissue Growth Factor - β

HLA

Human Leucocyte Antigen

BK

BK Polyoma virus

CMV

Cytomegalovirus

EBV

Epstein Barr virus

UNOS

United Network of Organ Sharing

N/A

not applicable

Copyright information

© IPNA 2006

Authors and Affiliations

  • Stephen I. Alexander
    • 1
  • Jeffrey T. Fletcher
    • 1
  • Brian Nankivell
    • 2
  1. 1.Centre for Kidney ResearchChildren’s Hospital at WestmeadWestmeadAustralia
  2. 2.Centre for Transplant and Renal ResearchWestmead HospitalWestmeadAustralia

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