de Kok MJ, Schaapherder AF, Mensink JW, et al. - As transplantation is declined for kidneys with an anticipated risk of early graft loss (EGL; graft loss within 90 days) and with optimal use of available donor kidneys, the donor pool size is balanced in the most favorable scenario by the risk of EGL, with a tradeoff dictated by the consequences of EGL, researchers here investigated the consequence of EGL via systematically appraising its influence in an observational study of 10,307 deceased-donor kidney transplantations performed in The Netherlands between 1990 and 2018. EGL incidence of 8.2% (699/8,511) was reported in primary transplantation. Graft rejection (30%), primary nonfunction (25%), and thrombosis or infarction (20%) were the main causes. They observed profound impact of EGL on short- and long-term patient survival. Of the EGL recipients who survived 90 days after transplantation (617/699), only 440 of the 617 were relisted for re-transplantation. A doubled incidence of EGL but similar long-term graft survival was reported in correlation with re-transplantation. Observations revealed EGL after kidney transplantation as a medical catastrophe with high mortality rates, low relisting rates, and increased risk of recurrent EGL following re-transplantation. This indicates involvement of convergence of risk factors in recipients with EGL as well in detrimental outcomes. Population mortality was minimally affected by the 8.2% incidence of EGL, suggesting this incidence as acceptable.