*Purpose: A consensus does not exist on whether to treat borderline lesions in the renal allograft. Importantly, recent data suggests that borderline lesions confer risk to long-term allograft survival. However, the long-term outcomes of borderline lesions found on for-cause biopsies based on treatment received have not been reported. This study presents 5-year outcomes of borderline lesions based on high-dose corticosteroid therapy or increased maintenance immunosuppression.

*Methods: Patients with a biopsy-proven borderline lesion from 2000 to 2014 who received rATG induction were included. All biopsies were for-cause. Patients with a prior biopsy-proven acute rejection (BPAR) or concurrent ABMR were excluded. Patients who were maintained on belatacept therapy or who received treatment for the borderline lesion other than increased maintenance immunosuppression (IS) or corticosteroid therapy were excluded.

*Results: Table 1 shows patient demographics and immunosuppression information. Figure 1 shows Kaplan Meier curves for progression to ACR, death or graft loss, and a composite of all 3 outcomes.

*Conclusions: This experience constitutes the longest duration of follow up of borderline lesions based on treatment. Treatment with high dose corticosteroids or increased maintenance immunosuppression did not significantly affect progression to death, graft loss, or acute rejection. In addition, treatment did not affect renal function or DSA development at five years post-borderline lesion diagnosis.

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