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Background.  Identification of patients at risk for kidney allograft (KAG) failure beyond the first posttransplant year is an unmet need. We aimed to determine whether serum beta-2-microglobulin ( β 2MG) in the late posttransplant period could predict a decline in KAG function.  Methods.  We assessed a value of single measurement of serum  β 2MG at one to seventeen years after transplantation in predicting the estimated glomerular filtration rate (eGFR) and the decline in eGFR over a period of two years in 79 recipients of KAG.  Results.  At baseline serum  β 2MG concentration was higher ( P  = 0.011) in patients with allograft dysfunction: 8.67 ± 2.48  µ g/mL versus those with satisfactory graft function: 6.67 ± 2.13  µ g/mL. Higher  β 2MG independently predicted the lower eGFR, the drop in eGFR by ≥25% after one and two years, and the value of negative eGFR slope. When combined with proteinuria and acute rejection, serum  β 2MG had excellent power in predicting certain drop in eGFR after one year (AUC = 0.910). In conjunction with posttransplant time serum  β 2MG had good accuracy in predicting certain eGFR drop after two years (AUC = 0.821).  Conclusions.  Elevated serum  β 2MG in the late posttransplant period is useful in identifying patients at risk for rapid loss of graft function.

High Serum Level ofβ2-Microglobulin in Late Posttransplant Period Predicts Subsequent Decline in Kidney Allograft Function: A Preliminary Study