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Adverse events occurring early after kidney transplantation were reported to influence graft outcome.In a prospective multicenter study initiated in 2001, we investigated the relationship between human leukocyte antigen (HLA) alloantibodies, early adverse events, and graft outcome.Pretransplant presence of HLA class I antibodies was associated with a higher rate of no immediate function (NIF) of the graft (odds ratio [OR] 1.78, P=0.023) and acute rejection episodes (ARE) during the first 3 months after transplantation (OR 2.53, P<0.001). NIF and ARE during posttransplant days 15 to 90 were associated with increased risk of graft loss to year 3 (OR 2.06 and 3.75, P=0.006 and P<0.001, respectively). ARE within the first 2 posttransplant weeks did not increase the risk significantly, especially if they occurred in nonsensitized patients without antibodies. Graft survival at 3 years in patients with both NIF and ARE during the first 3 months was significantly lower (81.3%±6.2%) than in patients who did not experience NIF or ARE (95.1%±1.0%, P<0.001). Importantly, neither NIF nor ARE had an impact on subsequent graft survival if good graft function (serum creatinine <130 μmol/L) was observed at the end of the third month.Our results show that NIF and ARE associated with pretransplant antibodies against HLA class I, and they suggest that early diagnosis and treatment of adverse events with the aim of obtaining normal 3-month graft function should be pursued rigorously. Good 3-month graft function is associated with excellent long-term survival, even in patients with pretransplant HLA antibodies and posttransplant adverse events.