In this report, we investigated the cell infiltration that expresses FOXP3 or IL-17 in allograft tissue with biopsy-proven ATCMR, and we intended to appraise whether the ratio between them is associated with allograft outcome after ATCMR. The study population consisted of 71 clinically indicated renal allograft biopsies performed on 56 renal transplant recipients in our transplant centre from August 1999 to August 2008. Of the 71 biopsy samples, 56 biopsies were a first-time ATCMR and the other 15 specimens

were repeat ATCMR biopsy samples (13 specimens were the second ATCMR and two specimens KU-60019 purchase were third ATCMR). The indication for the allograft biopsy was graft dysfunction defined as a serum creatinine increment of greater than or equal to 10% from the baseline value. These cases were selected only for the diagnosis of ATCMR type I or II according to Banff’s working classification and the availability of sufficient paraffin-embedded tissue.23,24 BK virus or cytomegalovirus nephropathy, www.selleckchem.com/products/Decitabine.html lymphoproliferative disorder, interstitial fibrosis/tubular atrophy (IF/TA) grade III was not present in these

patients or biopsies. Out of 56 patients, 33 patients (59%) were a living related donor, 13 cases (23%) were a living unrelated donor, and 10 cases (17·9%) were deceased donor transplantation. The HLA mismatch number was 3·7 ± 1·3 and four cases (7%) were a second transplantation. The flow-cross-match test before transplantation was negative and the Panel reactive antibody was less than 20% in all patients. Our centre’s protocol for immune suppression is described

in a previous publication.25 Briefly, the main immunosuppressive agents used were cyclosporine (n = 31, 55%) or tacrolimus (n = 25, 45%). Mycophenolate mofetil was added as a primary immunosuppressant in 42 patients (75%). Basiliximab was used as an additional induction therapy in 22 patients (39%). Patients were followed from the date of transplantation to the date of nephrectomy, permanent dialysis, re-transplantation, or Cytidine deaminase death. During the study period, ATCMR was treated with three to five daily boluses of intravenous methylprednisolone (500 mg/day), followed by a 5–7-day oral steroid taper. When the serum creatinine level failed to decrease within 5 days, muromonab-CD3 (OKT3) or anti-thymocyte globulin (ATG) was applied. The Institutional Review Board of Seoul St Mary’s Hospital approved the study. All biopsies were examined for FOXP3+ cell and IL-17+ cell infiltration. Paraffin sections were immersed in three changes of xylene and hydrated using a graded series of alcohols. Antigen retrieval was performed routinely by immersing the sections in sodium citrate buffer (pH 6·0) in a microwave for 15 min.