Allograft rejection is historically divided into cell-mediated and antibody-mediated categories, but these processes frequently occur in combination (mixed rejection), for example in allograft vasculopathy, and often with worse outcomes. 1,2 Human graft endothelial cells (ECs) are major participants in the effector phases of rejection because they alone among graft structural cells express high levels of class I and II MHC molecules that are the principal targets of donor-specific antibody (DSA), and with bound peptides, the principal antigens directly recognized by alloreactive T cells. 3 ECs also express a range of costimulators that preferentially engage effector memory T cells (T EM ), which is the circulating host T cell subset that correlates with T cell-mediated rejection. ECs can stimulate alloreactive CD8 + T EM to rapidly differentiate into cytotoxic T lymphocytes (CTL) that produce effector molecules, such as perforin, granzymes, and cytokines, 4-6 that kill grafts. Additionally, ECs rapidly stimulate different subpopulations of CD4 + to produce subsets of one or more cytokines that activate different effector cell types including CTLs, B cells, NK cells, and macrophages, all of which may contribute to