Cherukuri A, et al. - Given a relation between post-transplant donor specific antibody (DSA) and poor renal allograft outcomes, researchers performed a prospective analysis of non-desensitized patients in order to investigate the factors related to poor four-year outcomes in patients who developed post-transplant DSA. An increased incidence of both clinical and subclinical T-cell–mediated rejection (TCMR) was observed in patients with DSA vs those who did not develop DSA. An approximately three-fold increase in graft loss was observed in relation to the combination of TCMR plus DSA vs either DSA or TCMR alone. Overall, an increased incidence of TCMR was observed in relation to early post-transplant DSA, particularly in non-adherent patients. Cases with early post-transplant DSA had a high-risk and might derive benefit from targeted therapeutic interventions.