Knowing the allograft’s destiny

Over the past 50 years the short term outcome of kidney transplantation has improved significantly but maintaining the graft long term has remained a challenge (1). Today, with the help of calcineurin inhibitors, we are able to keep the acute rejection rates low (less than 10%) (2). However, we have very few weapons in our armamentarium to identify and influence the chronic process like transplant glomerulopathy, interstitial fibrosis and tubular atrophy (1,3). Hence the importance of markers to identify grafts at risk for these chronic changes before they become permanent and irreversible.