Chronic renal transplant rejection

Last revised by Dr Karwan T. Khoshnaw on 06 Dec 2019

Chronic renal transplant rejection is a form of renal transplant rejection. It usually later following transplantation.

Chronic rejection is defined as a gradual deterioration in graft function beginning at least 3 months after transplantation 3

The creatinine levels may rise but this does not allow differentiation from acute transplant rejection.

Histological diagnosis is made a demonstration of graft arteries and arteriolar proliferation, interstitial cellular infiltration and fibrosis, tubular atrophy, and glomerular changes.

  • previous episodes of acute rejection

Imaging of choice. features include

  • mild dilatation of the collecting system: may occasionally be seen in cases of chronic rejection.
  • the cortex may be thin
  • narrowing at the ureterovesical junction
  • focal pyelonephritis
  • elevated renal arterial resistive indices

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