This is a single center, retrospective cohort study showing the impact of pre-transplant HLA-DSA (detected by the SAFB) on early posttransplant rejection rates. Our results showed that low level pretransplant DSA detected by SAFB is associated with a high risk of early clinical AMR. However, not all patients with pretransplant DSA will go on to develop AMR. Post-transplant with a decrease/removal of DSA within one month will lead to a low rate of AMR. Conversely, those who have a high DSA MFI are at the highest risk of early AMR. These findings support using SAFB for pretransplant assessment and early posttransplant monitoring.