Can acute cellular rejection occur 27 years after a successful renal transplant :?

In an effort to reduce long-term complications of immunosuppressive medications, some investigators have devised protocols of reduced dosage that are intended to maintain the stability of the transplant. Implicit in this plan is the assumption that there has been the development of some degree of graft acceptance and/or tolerance. Yet it is also true that drug noncompliance is a common cause of late acute rejection and graft loss in stable kidney recipients. The latter fact is a warning that immunosuppression should be cautiously and gradually reduced. Herein, we present a case of acute cellular rejection that occurred after 27 years of stable renal graft function. This case provides evidence to support the concept that graft foreignness may persist indefinitely.