*Purpose: Donor-specific antibodies (DSA) negatively impact graft survival, the clinical relevance of non-donor-specific anti-HLA antibodies (NDSA) is unclear. Hence, the purpose of our study is to investigate the long-term effect of anti-HLA antibodies on renal allograft function.

*Methods: In a retrospective single-center study all patients receiving a first kidney transplant at the University hospital of Zurich between 01/2006 and 02/2015 with maximal follow-up until 03/2016 were investigated. Patient were stratified according to their last Luminex test results: A) no anti-HLA antibodies and B) anti-HLA antibodies with sub-analysis of patients with DSA (B1) and NDSA (B2). To analyze the functional impact eGFR slopes were calculated by linear regression, starting from 12 months post transplantation and compared between the groups.

*Results: Out of 238 patients analyzed, a total of 132 patients (55%) showed no anti-HLA antibodies during the median follow-up time of 2047 days, while 106 patients (45%) developed anti-HLA antibodies during a median follow-up time of 1781 days. While allograft function remained stable or slightly improved in patients without anti-HLA antibodies, preformed or de novo DSA were associated with significant functional deterioration already during the first observation period of 12-24 months post-transplantation (-1.3 ml/min/m2/year, p=0.015). However, in the long-term follow up both DSA (n=73) and also NDSA (n=33) were associated with a significant deterioration in allograft function, irrespective of donor-specificity [months 12-48: no anti-HLA antibodies: 0.7ml/min/m2/year; DSA: -1.5 ml/min/m2/year (p= 0.015), NDSA -1.6 ml/min/m2/year, p=0.019)].

*Conclusions: In detail long-term analysis of kidney function indicates a negative impact not only of donor-specific but also of non-donor-specific anti-HLA antibodies.

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