In the 2005 Banff update, the classification has controversially expanded the borderline T-cell rejection (BL-R) category to include: “foci of tubulitis with minor/absent interstitial infiltration; or interstitial infiltration with mild tubulitis”; while excluding samples with any intimal arteritis. Currently, the management of BL-R is still under debate with no final guideline to manage this category. This study will review the clinical course of patients whose renal allograft biopsies showed "borderline changes" to determine how often these histologic findings actually represented acute rejection and the outcome of each patient depending on how they were managed. We will determine if there are any adverse long-term consequences of BL-R. A retrospective, single center study was performed in all kidney transplant recipients with biopsy of BL-R between January 1, 2010- December 31, 2015. Donor and recipient characteristics, subsequent repeat biopsy and serum creatinine at 3 months, 6 months, 1-year, 2-years and 3-years post biopsy were collected. All patients who were treated were given IV methylprednisolone pulsing 500 mg TIV once a day for 3 consecutive days. Clinical outcomes to be determined on these cases will be doubling of serum creatinine, return to dialysis or a repeat kidney transplant, or death. Kaplan Meier survival analysis generated to determine the graft loss among borderline T-cell rejection among kidney transplant recipients. We included 153 patients with biopsy proven BL-R. Baseline and clinical characteristics of those given and were not given treatment were homogenous or no difference between the 2 groups. Median graft loss of those not given treatment was 84 months (95% CI 57.1 to 110.9 months) while those given was 77 months (95% CI 48.6 to 105.4 months) (Figure 1). The overall median duration of graft loss was 84 and 95% CI 64.4 to 103.6 months. There is no sufficient evidence to show that there is a difference between the 2 groups with p-value of 0.963. View Large Image Figure ViewerDownload Hi-res image Download (PPT) In summary, we found no statistically significant difference in demographics, clinical, immunologic risk profile and immunosuppression among allograft recipients presenting with BL-R whether treated or non-treated. Our study showed that there was no difference in renal outcomes and allograft survival of BL-R with dysfunctional renal allograft among treated and non-treated recipients.