There is increasing evidence that antibodies to non-HLA antigens such as antigens present on endothelial cells may be detrimental and targets for graft rejection. The aim of this work was to detect AECAs in patients with end-stage renal disease (ESRD) awaiting transplantation and correlate this with graft outcome. Sixty ESRD patients were enrolled into the study. All patients were subjected for routine HLA typing (class I and II antigens) and cross match technique. Sera from the patients were collected for detection of AECAs by ELISA technique. According to the presence or absence of AECAs the patients were divided into 2 groups; Group I: 40 patients with AECAs +ve, and Group II: 20 patients with –ve AECAs. We observed a statistically significant higher serum creatinine levels (mg/dl) in group I compared to group II at 1 (P=0.04) and (P=0.04) at 12 month after transplantation. There was no statistically significant difference in the incidence (P=0.5), or the severity (P=0.4) of acute rejection episodes, but there was a statistically significant frequent attacks (22 vs. 6 in group I and II, respectively; P=0.04). At last follow-up, there was 3 graft losses, one of them due to death with functioning graft in group I, 1 graft loss in group II (P=0.8). Kaplan-Meier at 5 year graft survival was not statistically significant (P=0.1). Detection of anti endothelial cells antibodies before kidney transplantation may be of value. Larger number of patients and longer follow up period may be warranted to confirm our results.