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The presence of donor‐specific anti‐HLAantibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAsagainst HLAclass I, class II,or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long‐term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement‐dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAsagainst class I or IIantigens after transplant. Class I and II DSAscombined resulted in decreased 10‐year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAshad a 10‐year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs(76%). The combination of class I and II DSAsresulted in a 10‐year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAsare a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAsseem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence. Via a retrospective multicenter study, the authors investigate the impact of pretransplant donor‐specific HLA antibodies on long‐term graft survival in deceased and living donor kidney transplantations.

In a 24‐month, multicenter, open‐label, randomized trial, 715 de novokidney transplant recipients were randomized at 10–14 weeks to convert to everolimus (n = 359) or remain on standard calcineurin inhibitor (CNI) therapy (n = 356; 231 tacrolimus; 125 cyclosporine), all with mycophenolic acid and steroids. The primary endpoint, change in estimated glomerular filtration rate (eGFR) from randomization to month 12, was similar for everolimus versus CNI: mean (standard error) 0.3(1.5) mL/min/1.732versus −1.5(1.5) mL/min/1.732(p = 0.116). Biopsy‐proven acute rejection (BPAR) at month 12 was more frequent under everolimus versus CNIoverall (9.7% vs. 4.8%, p = 0.014) and versus tacrolimus‐treated patients (2.6%, p < 0.001) but similar to cyclosporine‐treated patients (8.8%, p = 0.755). Reporting on de novodonor‐specific antibodies (DSA) was limited but suggested more frequent anti‐HLAClass I DSAunder everolimus. Change in left ventricular mass index was similar. Discontinuation due to adverse events was more frequent with everolimus (23.6%) versus CNI(8.4%). In conclusion, conversion to everolimus at 10–14 weeks posttransplant was associated with renal function similar to that with standard therapy overall. Rates of BPARwere low in all groups, but lower with tacrolimus than everolimus. In a multicenter, open‐label, randomized trial of de novokidney transplant recipients, conversion to everolimus at 10–14 weeks posttransplant is associated with similar renal function as in patients who continue to standard tacrolimus or cyclosporine therapy, with low rates of biopsy‐proven acute rejection in all groups, but lower rates with tacrolimus than everolimus.