Chronic allograft nephropathy (CAN) and death with graft function have been the leading
causes of late kidney graft loss in the last 20 years. The term CAN substituted the old term “chronic
allograft rejection” and designs a poorly understood condition characterized by a progressive decline of
graft function often associated with hypertension and proteinuria and non-specific histologic changes
affecting all kidney compartments. As CAN includes many specific chronic diseases caused by
different etiopathogenic mechanisms, workers attending the 8th Banff Conference on Allograft
Nephropathy decided to eliminate and to replace the term CAN by “interstitial fibrosis and tubular
atrophy without evidence of any specific etiology”. The implications of this change in the future could
probably be of paramount importance and contribute to a better understanding and treatment of the
different entities included in the term CAN. In the present chapter, the different conditions associated
with a progressive decline of graft function such as interstitial fibrosis and tubular atrophy, transplant
glomerulopathy, chronic T-cell mediated rejection and calcineurin inhibitor toxicity are described, with
special emphasis on the clinical course, the possible etiopathogenic mechanism, the diagnostic criteria
and the different therapeutical options.
Keywords: Kidney Transplantation, Graft Dysfunction, Immunosuppression, Chronic Allograft
Vasculopathy, Interstitial Fibrosis, Tubular Atrophy, Transplant Glomeruolpathy, Calcineurin Inhibitors,
Calcineurin Toxicity, Kidney Biopsy.
