Clinical indicators, such as steroid-resistant ATCMR, incomplete functional recovery after anti-rejection treatment, recurrence of ATCMR within 6 months after a previous ATCMR episode, and allograft survival rate after ATCMR, were compared according to the FOXP3/IL-17 ratio. Steroid-resistant ATCMR was defined when serum creatinine levels did not return to within 20% of baseline within 5 days

after the last steroid pulse, and incomplete functional recovery was defined when the anti-rejection treatment did not recover allograft function to within 10% of the baseline value.26 selleck products The baseline estimated glomerular filtration rate was calculated from the stable serum creatinine concentration at 2 to 4 weeks before the ATCMR episode by using the modified diet in the renal disease formula.27 Recurrence of ATCMR within 6 months was evaluated in 52 patients after exclusion of four patients who suffered allograft failure immediately after the

first ATCMR. Statistical analysis was performed using spss software version 16·0 (SPSS Inc., Chicago, IL). Data are presented as mean ± SD or counts and percentages, depending on the data type. For continuous variables, means were compared using Student’s t-test. For categorized variables, Pearson’s chi-square test and Fisher’s exact test were used. Allograft survival was analysed by the Kaplan–Meier method with a log-rank test, and it was censored in cases of patient death with a functioning allograft. Cox regression analysis was used for the multivariate Decitabine analysis to evaluate

risk factors for allograft failure. The results were considered significant when the P value was below 0·05. Demographic and pre-transplant baseline characteristics did not differ significantly between the FOXP3 high and the IL-17 high groups (Table 1). However, in the FOXP3 high group, the proportion of patients who took basiliximab as an induction therapy was higher (P = 0·03). Interval from transplantation to biopsy was 8·5 ± 14·7 months. Time from transplantation to biopsy and the proportion of late-onset ATCMR (> 6 months from transplant) did not differ significantly between the FOXP3 high and IL-17 high groups (Table 2). Calculated estimated glomerular filtration rate at biopsy was significantly ADAMTS5 decreased in the IL-17 high group compared with the FOXP3 high group (31·4 ± 15·2 ml/min versus 41·6 ± 15·5 ml/min, P = 0·04). Serum creatinine at biopsy was higher in the IL-17 group compared with the FOXP3 group, even though it did not reach statistical significance (2·9 ± 1·8 mg/dl versus 2·3 ± 1·3 mg/dl, P =0·08) (Table 2). Based on the Banff classification, the distribution of the ATCMR stage did not differ significantly between two groups (P = 0·39). However, the development of IF/TA was significantly higher in the IL-17 high group (P =0·04).