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The median follow-up after transplantation was 3.4 years .001) . Dialogue In a cohort of 1016 phenotyped kidney-transplant recipients, we observed that the current presence of complement-binding donor-specific anti-HLA antibodies detected in the first year after transplantation was an unbiased predictor of kidney-allograft loss more than 5 years after transplantation and significantly improved individual risk stratification for graft failure. Patients with complement-binding donor-specific anti-HLA antibodies after transplantation experienced a graft injury phenotype characterized by microvascular inflammation and complement split-product C4d deposition. In comparison with a traditional method of predicting graft loss, based just on the current presence of donor-particular anti-HLA antibodies after transplantation as a risk factor for graft reduction, the approach we utilized, which integrates the capacity of donor-particular anti-HLA antibodies to bind complement, identified yet another band of patients with an increased threat of graft loss.