role of de novo donorspecific antihla antibodies in kidney graft failure a casecontrol study the role of de novo donorspecific antihuman leukocyte antigen antihla antibodies dndsa within the pathways leading to graft failure remains not fully understood we investigated 56 patients who were transplanted between 2002 and 2014 with kidney graft failure cases for a possible association of development of dndsa with graft failure the 56 patients with failed transplants were matched with 56 patients with a functioning graft at present for the variables deceased or living donor transplant number transplant year recipient age and gender donor age and gender dialysis vintage time transplant induction therapy all patients had at least one serum collected 1 year before failure in cases or end of followup in controls cases and controls were very wellmatched in several baseline characteristics posttransplant antihla antibodies were found in 84 of cases and only 36 of controls p 001 with 54 of cases and 16 of controls p 001 having dndsa at time of detection chronic active antibodymediated rejection was significantly more common p 001 in patients with dndsa 61 vs 12 in 53 47 patients that had at least one graft biopsy performed during followup dndsa was a significant risk factor odds ratio or 606 p 003 for graft failure in a multivariable conditional logistic regression model dndsa as a timedependent variable was also an independent predictor hazard ratio hr 246 p 002 of graft failure in a multivariable cox regression analysis in both statistical approaches only dndsaii or 1190 p 006 hr 230 p 014 was significantly associated with graft failure posttransplant dndsa was clearly associated with graft loss particularly if against hla class ii antigens dndsa detection should be a tool for posttransplant monitoring of kidney graft recipients allowing for the identification of those with a higher risk of graft failure