Ellingsen AR, Jørgensen KA, Østerby R, et al. - Via this prospective cohort study, researchers aimed at examining correlations between structural and ultrastructural parameters in baseline biopsies from human kidney transplants and long-term graft survival after more than 14 years’ follow-up. Baseline kidney graft biopsies obtained from 54 consecutive patients receiving a kidney transplant at a single institution were examined. Per findings, less arteriolar hyaline thickening and less interstitial fibrosis, as well as a lower fraction of occluded glomeruli and lower glomerular volume, at implantation characterized the long-term surviving kidney transplants. At the latest follow-up, they observed decrease in eGFR by 12 ml/min/1.73 m² per unit rise in the score for arteriolar hyalinosis at implantation, and decrease in eGFR by 19 ml/min/1.73 m² per 106 μm³ increase in glomerular volume at baseline. Evaluation of the unbiased Cavalieri estimate of glomerular volume and the ultrastructural parameters was done for the first time in a cohort study with prospective follow-up for more than 14 years. These findings suggest that baseline biopsies from human kidney grafts yield extraordinary long-term prognostic information highlighting the importance of the intrinsic graft factors.