Chronic Allograft Injury

Schema of the potential sites of injury associated with late allograft failure. There may be “fixed” injury as a consequence of the donation and transplant process (“pretransplant injury”). Three target sites of injury within the kidney are shown, with defined histologic characteristics. The entities that contribute to these sites directly (solid arrows) are shown aligned to their injury at that site. There may also be “crosstalk” of disease processes between compartments (hashed arrows) as well as cumulative injury from multiple entities directly (solid arrows) or indirectly (hashed arrows). ATN, acute tubular necrosis; CNI, calcineurin inhibitor; UTI, urinary tract infection.