Special Feature A Case of Late Kidney Allograft Failure: A Clinical Pathological Conference from American Society of Nephrology Kidney Week

Introduction With the advent of more potent immunosuppression, early outcomes after kidney transplantation have been excellent. However, long-term graft survival has improved at a slower pace and does not reflect the substantial gains made in the early post-transplant period (1). Identification of the failing kidney allograft is based on the detection of alteration in GFR, using serum creatinine as the primary surveillance tool. About half of late graft failure is associated with specific pathology within the kidney allograft and allograft biopsy is a key tool to manage and diagnose late injury (2). In the following clinical case presentation from Kidney Week 2011, we present a case of late allograft failure after an initial early acute rejection and a period of apparent clinical stability. The case is instructive in identifying the causes of late kidney injury and demonstrates the role of allograft biopsy in assisting in the critical management of recipients with declining kidney function. Proper intervention even in the late post-transplant period may alter the course and ameliorate the decline in allograft function.