Chronic renal transplant rejection

Last revised by Dr Rohit Sharma on 10 Feb 2022

Chronic renal transplant rejection is a form of renal transplant rejection.

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 by 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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