Thus, anti-HLA class II antibody was seen in a total of 48 samples (72%). Of the 55 samples with anti-HLA antibodies, the antibodies check details were donor-specific anti-HLA antibodies (DSA)

in 33 samples (49%), including class I antibody alone in two samples (3%), class II antibody alone in 27 samples (40%), and both class I and II antibodies in four samples (6%) (Table 4). Thus, class II DSA antibody was seen in a total of 31 samples (46%). de novo DSA was detected in 10 samples (15%), including class I antibody alone in two samples (3%), and class II antibody alone in eight samples (12%). Among our study, 22 BS (26%) met all the criteria for c-AMR in the Banff ’09 classification, including TG, C4d deposition in the PTC and presence of DSA, while 27 BS were diagnosed

as suspicious of c-AMR. The prognoses of the patients with TG are shown in Table 5. Eleven cases lost their graft during the observation period. Three patients were dead with a functioning graft. Of the other cases with functioning grafts, deterioration of the renal allograft function after the biopsies was seen in 20 patients (40%). TG is a pathologic condition of renal allografts Adriamycin datasheet that was recognized more than four decades ago.[5] TG has been widely recognized as a pathological change of chronic rejection. TG is included as a criterion of chronic allograft nephropathy (CAN) with chronic rejection in the Banff 97 classification, and of c-AMR in the Banff 05, 07 and ‘09 classifications.[2, 3, 6, 7] The risk Baf-A1 in vitro of TG is higher in patients with a history of AMR. Sis et al. reported a high incidence

of previous rejection (54%), in their clinically indicated biopsy study.[8] Other studies have reported that approximately 45% of patients with a-AMR later developed TG as compared with 6% of recipients without rejection.[9, 10] In our study, 42 of the 50 patients (84%) had experienced rejection episodes prior to this study, of which 30 (60%) patients had experienced a-AMR episodes; in the latter patients, the a-AMR might have progressed to TG. The clinical manifestations of transplant glomerulopathy include progressive loss of kidney allograft function and proteinuria.[1] In the earlier stages, the patients may have mild sub-nephrotic-range proteinuria and unexplained mild deterioration of graft function.[1] Proteinuria of more than 1+ by dipstick test was present in 27 of the 50 patients (54%) in our study. The median serum creatinine level at the time of the allograft biopsy was not very high, being 1.77 mg/dL. Based on these findings, we consider that some of our patients had subclinical TG. In this study, TG was characterized mainly by peritubular capillaritis (86%), followed in frequency by transplant glomerulitis (76%) and IF/TA (83%). Thickening of the basement membrane of the PTC (ptcbm) was also found in 71% of cases.