*Purpose: Intimal arteritis belongs between diagnostic criteria of both antibody-mediated rejection (AMR) and T cell-mediated vascular rejection (TCMRV). Patients with intimal arteritis must be assessed carefully in context of accompanying histologic finding- tubulointerstitial inflammation or microvascular inflammation (MVI) and DSA status.

*Methods: We retrospectively assessed 881 patients transplanted between Jan 2014 and Dec 2017 in order to evaluate outcome of early (up to 12 months) intimal arteritis in context of other AMR histologic findings both in presence and absence of DSA. Patients with v-lesion, glomerulitis and peritubular capillaritis were involved. Intimal arteritis in absence of MVI and DSA was found in 24 patients (category TCMRV, N=24), intimal arteritis with MVI in absence of DSA in 31 (AMRV/DSA-, N=31), intimal arteritis with MVI and DSA positivity in 17 (AMRV/DSA+, N=17). Furthermore 61 patients with MVI and DSA positivity (AMR/DSA+, N=61) and 49 patients with MVI in absence of DSA (AMR/DSA-, N=49) were included.

*Results: Kaplan-Meier estimate of death-censored graft survival at 12 months was 100% in TCMRV, 100% in AMR/DSA-, 92% in AMR/DSA+, 94% in AMRV/DSA- and only 88% in AMRV/DSA+. Mean graft survival time was 69 months (95% CI, 65-73) in TCMRV, 70 months (95% CI,68-72) in AMR/DSA-, 56 months (95% CI, 50-62) in AMR/DSA+, 64 months (95% CI, 57-70) in AMRV/DSA- and 46 months (95% CI, 34-58) in AMRV/DSA+, Log Rank<0.0001. Transplant glomerulopathy was observed in 0 TCMRV, 9 (18%) AMR/DSA-, 29 (47%) AMR/DSA+, 13 (42%) AMRV/DSA- and 12 (71%) AMRV/DSA+ patients, (p<0.0001).

*Conclusions: According to our observation DSA negative patients with intimal arteritis along with microvascular inflammation have comparable incidence of transplant glomerulopathy and graft survival at early posttransplant time period to DSA positive antibody-mediated rejection. Harmful influence of non-HLA antibodies might be considered in these cases.

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