Fate of renal allografts that survive vascular rejection To measure the outcome for grafts that survive early vascular rejection, we reassessed 411 biopsy samples taken from 260 patients in the first month after transplantation. Patients were separated into four classifications, according to Banff 1997 criteria: vascular rejection (36 patients); acute cellular rejection ([ACR] 30); no rejection (194); and 974 recipients from the same era who did not undergo biopsy. Other than graft histology, the groups did not differ for known adverse prognostic factors. The mean follow-up period was 6·03 years (SD 4·7). Graft survival is presented in the table. The graft attrition rate for the ACR group was significantly higher than for the no rejection group (6·5 vs 3·8% per year) and no biopsy groups (6·5 vs 2·8% per year). In the group that experienced vascular rejection in the 1st month after transplantation, 12 (33%) grafts were lost to the first episode. These grafts failed within 4·3 weeks (SD 3·3). Two grafts recovered marginal function and failed within the 1st year. However, after 6 months, the rate of graft loss for survivors of vascular rejection (2·3% per year) is significantly less than that seen in the ACR or no rejection groups. Only four (11%) grafts failed because of chronic rejection.