This is the least characterised from of rejection and probably represents a final common pathway of several phenomena. It is felt to be due to ongoing microvascular endothelial damage by either antibody of cell mediated processes.
Graft deterioration is slow and insidious and the histological findings are characteristic for a particular organ. This chronic allograft nephropathy is the main cause of loss of the transplant organ in the long term. The half life of a kidney transplant is about 14 years. This means that half of all kidneys will be lost within 14 years and the process continues.