Furthermore, it is an important risk factor for poor clinical outcome with ATCMR. This finding MK-2206 order suggests that it could be a useful marker for predicting the prognosis of an allograft after ATCMR. We

evaluated the severity of allograft dysfunction and tissue injury between the FOXP3 high and the IL-17 high groups, and our results showed that more severe allograft dysfunction and tissue injury were observed in the IL-17 high group compared with the FOXP3 high group. In the IL-17 high group, the tissue injury score for acute and chronic inflammation of the interstitial area and tubule was higher than in the FOXP3 high group. This finding suggests that the IL-17-dominant state is associated with both acute and chronic injuries, and previous reports may support this presumption in that acute inflammation induces the IL-17-dominant condition and, in turn hastens chronic changes in the allograft tissue in

turn.28 We also evaluated the clinical indicators of ATCMR, which represent poor prognosis (steroid-resistant ATCMR, incomplete recovery, and recurrence of ATCMR) between the FOXP3 high and the IL-17 high groups. The results showed that all indicators in the IL-17 selleck products high group were higher than in the FOXP3 high group. The reason for this result is still unclear but we speculate several possibilities. First, renal epithelial cells exposed to IL-17 can produce inflammatory mediators with the potential to stimulate early alloimmune responses.29 Second, IL-17 could rapidly recruit neutrophils, which are observed frequently in biopsies with more severe rejection.30 Third, IL-17 could drive alloimmune responses

by promoting lymphoid neogenesis.28 Therefore, it is possible that exposure to relatively higher levels of IL-17 during Cyclin-dependent kinase 3 ATCMR induces stronger alloimmune responses and results in a poor clinical outcome in ATCMR. As observed, with poor clinical outcome in the IL-17 high group, the FOXP3/IL-17 ratio also affected significantly the long-term allograft survival after ATCMR. The allograft survival rate at 1 year (90% versus 54%) and 5 years (85% versus 38%) in the FOXP3 high group was higher than in the IL-17 high group (P = 0·00) (Fig. 2d). Furthermore, multivariate analysis revealed that the FOXP3/IL-17 ratio is a significant prognostic factor independent of other important confounding factors, such as chronic tissue injury and allograft dysfunction. This suggests that the IL-17-dominant state is not secondary to the outcome of allograft dysfunction or chronic tissue injury. In patients who suffered from multiple episodes of ATCMR, the FOXP3/IL-17 ratio decreased in the repeat ATCMR compared with the first ATCMR in all patients (Fig. 3).