*Purpose: ^{TruGraf®, can be used as an alternative to surveillance biopsies for ruling out “silent” subclinical acute rejections in transplant patients with stable graft function. However, its role in patients with graft dysfunction is unclear. The purpose of our study was to analyze the significance of Trugraf testing in kidney transplant previously biopsied for allograft dysfunction.}

*Methods: ^{Serum creatinines of kidney transplant recipients who had previously undergone a for cause allograft biopsy and subsequent Trugraf were analyzed. The patient’s were divided into four groups based on BPAR and Trugraf result: 1.BPAR+/NotTx, 2.BPAR-/NonTx , 3.BPAR-/Tx, 4. BPAR-/Tx-}

*Results: 23 patients who had undergone a kidney transplant biopsy for allograft dysfunction followed by a subsequent Trugraf test were analyzed. Donor type: 4 LTx and 19 DDTx, Avg. Mismatches; 5.03(1-6mm), Induction I/S; rATG 21, Simulect 2, mean duration between the biopsy and trugraf testing; 9.21 months (1-43 months). The number of BPAR+=15, BPAR- = 7, Not Tx = 12 and Tx were 11. The mean serum Cr for BPAR+/NotTx, BPAR-/NonTx , BPAR-/Tx, BPAR-/Tx- were 2.25 mg/dl(1.8-2.7 mg/dl), 1.90 mg/dl(1.2-3.34 mg/dl), 1.36 mg/dl(0.65mg/dl-2.43 mg/dl), 1.14 mg/dl(0.92-1.29mg/dl).

*Conclusions: In this small observational study of allografts previously biopsied for dysfunction, the renal function was worse for allografts with previous BPAR and a subsequent NonTx Trugraf results and best in allografts with no BPAR and a Tx Trugraf. Trugraf surveillance of allografts with previous history of dysfunction may help to identify and stratify ones at a higher risk of deteriorating renal function. More data is being collected prospectively.

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