Despite improved early graft survival long-term graft loss rate hasn’t been reduced. Both HLA antibodies and HLA donor specific antibodies (DSA) have been shown and causal in acute and chronic allograft nephropathy (CAN) particularly the former. In a longitudinal study, HLA antibodies were linked to graft failure. Recently, Class II DSA has been shown correlated to renal graft failure with graft surviving at least one year.