We studied the phenotype of late kidney graft failure in a prospective study of unselected
kidney transplant biopsies taken for clinical indications. We analyzed histopathology, HLA
antibodies and death-censored graft survival in 234 consecutive biopsies from 173 patients,
taken 6 days to 31 years posttransplant. Patients with late biopsies (> 1 year) frequently
displayed donor-specific HLA antibody (particularly class II) and microcirculation changes,
including glomerulitis, glomerulopathy, capillaritis, capillary multilayering and C4d staining …