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Super long‐term surviving two renal grafts with severe arteriolosclerosis and glomerulosclerosis

Two long‐term renal transplant survivors, for about 20 yr, with unusual histological features in the allograft kidney are reported.  In both cases, marked hyalinosis was observed in the arterioles of the transplanted kidney, despite never having been administered cyclosporine or tacrolimus. The cause remains unknown at the present time, but we think that the changes could be multifactorial in origin, including due to aging of the graft, hypertension, hyperlipidemia and chronic rejection.  We conclude that histological analysis of the allograft kidney must be performed in long‐term renal transplant survivors, in order to understand the histological changes in the chronic phase after kidney transplantation and to predict the prognosis of the graft.