Ix et al1 suggest that urine α1-microglobulin (A1M) in kidney transplant recipients is an independent predictor of transplant failure. We question their conclusions. We measured urine A1M at 12 months after transplantation in 161 adults with stable kidney function.2 Urine A1M level was independently associated with serum creatinine concentration, likely explained by previous rejections, use of brain-dead donor, donor age, and calcineurin-inhibitor use. During 72 months of follow-up, estimated glomerular filtration rate (eGFR) decreased by 0.3mL/min/1.73m2 per year, 24 patients died, and 6 patients developed transplant failure.