In all varieties of organ transplants, early results have dramatically
improved over the past two decades and failures due to acute rejection
are becoming rarer. Efficient immunosuppressive regimens have been
developed with the objective of very good results at 1, 3 and 5 years.
Successful transplants, however, are significantly less frequent at 10
and 20 years, and many patients require retransplantation. Many factors
are involved in late graft loss and it is now well recognized that, in
addition to chronic rejection, a number of non-immunologic factors play
a prominent role. In the case of renal transplantation, a reduced mass
loss (transplantation of a single kidney, sometimes from an aged donor,
ischemic injury and alteration of some nephrons in the case of early
acute rejection) will result in slowly progressing chronic renal
failure, even in the absence of any supplementary attack of an
immunological nature. The new treatments must be analyzed in the light
of their capacity to reduce these late failures. Several preventive
measures can also limit both immunologic and non-immunologic factors of
late transplant deterioration.