As therapy for acute rejection has improved, the major cause of the failure of vascularized organ allografts has become chronic rejection. Since 1990, 1-year survival of kidney allografts has been better than 90% but the 10-year survival has remained about 60% despite advances in immunosuppressive therapy. Chronic rejection develops insidiously during months or years and may or may not be preceded by episodes of acute rejection. Chronic rejection of different transplanted organs is associated with distinct pathologic changes. In the kidney
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