2026 Volume 14 Issue 1 Pages 75-86
Although kidney transplant graft survival rates in Japan are favorable, graft loss still occurs in a certain proportion of patients. Overcoming chronic active antibody-mediated rejection and chronic active T cell-mediated rejection, both major causes of graft dysfunction, remains an important challenge ; however, no established therapy is currently available in Japan. In addition, nephron mass reduction resulting from various causes and interstitial fibrosis induced by glomerular hyperfiltration further accelerate allograft injury. Moreover, the worsening of conventional lifestyle-related diseases, including hypertension, dyslipidemia, diabetes mellitus, and hyperuricemia, as well as adverse effects associated with immunosuppressive agents, are also expected to exacerbate graft dysfunction in addition to immunological risks. In this review, we discuss the potential strategies for overcoming these non-immunological factors contributing to kidney allograft dysfunction based on the latest clinical practice guidelines. Furthermore, we address the potential application of the recently advocated “Fantastic Four” therapeutic concept to kidney transplant recipients.
