ABSTRACT
A number of insights noted years ago have supported a role for immunological events in chronic kidney graft failure. For example, HLA-identical kidney grafts enjoy a longer functional half-life.5 Even in the context of newer immunosuppressive strategies, at 10 years, 52% of HLA-matched grafts survive compared to only 37% of HLA-mismatched grafts.6 Secondly, acute rejection has been linked to chronic graft failure in kidney allografts, by a process called chronic allograft nephropathy (CAN).7 9 The impact of acute rejection on CAN has been rising despite use of newer immunosuppressants.10 Furthermore, there is improved graft survival for living related al lografts compared to cadaveric grafts.11,12 These clinical observations support the notion that immunological injury is a critical contributor to allograft failure.
