Antibody-mediated rejection (ABMR) is a major obstacle to the long-term success in kidney transplantation. Diagnosis of ABMR is determined according to the internationally recognized Banff criteria. However, a significant proportion of patients does not meet all the defined criteria, and the outcome of such cases remains poorly understood. The histology of ABMR frequently lacks sensitivity and specificity. More importantly, mixed forms of ABMR and T cell-mediated rejection as well as findings of nonspecific injury are common in clinical settings. Donor-specific anti-HLA antibodies (DSA) are detectable only in half of the ABMR cases by histology. Prognostic role of non-HLA antibodies against various endothelial proteins has been discussed. Antibody independent NK cell activation reflecting killer-cells' inhibitory receptor incompatibility is suggested in microvascular inflammation in DSA negative patients. Molecular assessment of ABMR has been prioritized to overcome high interobserver variability and improve diagnostics in mixed forms of rejections and in DSA negative cases. Finally, donor-derived cell-free DNA detected in a recipient's peripheral blood sample has been proposed as a noninvasive marker for diagnosis of graft rejection, and thus might serve as a liquid biopsy in the near future. Despite all achievements, diagnosing ABMR in kidney allografts remains to be a challenge in a significant number of cases.

Department of Nephrology Institute for Clinical and Experimental Medicine Prague Czech Republic

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AMROUCHE L, AUBERT O, SUBERBIELLE C, RABANT M, van HUYEN JD, MARTINEZ F, SBERRO-SOUSSAN R, SCEMLA A, TINEL C, SNANOUDJ R, ZUBER J, CAVALCANTI R, TIMSIT MO, LAMHAUT L, ANGLICHEAU D, LOUPY A, LEGENDRE C. Long-term Outcomes of Kidney Transplantation in Patients With High Levels of Preformed DSA: The Necker High-Risk Transplant Program. Transplantation. 2017;101:2440–2448. doi: 10.1097/TP.0000000000001650. PubMed DOI

ANAND S, LOPEZ-VERDUGO F, SANCHEZ-GARCIA J, DONG L, FIFE M, KRONG J, MORRIS D, SRINIVAS TR. Longitudinal variance of Donor-Derived Cell-Free DNA (dd-cfDNA) in Stable Kidney Transplant (KTx) patients are influenced by donor/recipient variables. Clin Transplant. 2021 doi: 10.1111/ctr.14395. online ahead of print. PubMed DOI

BRAY RA, TARSITANI C, GEBEL HM, LEE JH. Clinical cytometry and progress in HLA antibody detection. Methods Cell Biol. 2011;103:285–310. doi: 10.1016/B978-0-12-385493-3.00012-7. PubMed DOI

BUELOW R, MERCIER I, GLANVILLE L, REGAN J, ELLINGSON L, JANDA G, CLAAS F, COLOMBE B, GELDER F, GROSSE-WILDE H. Detection of panel-reactive anti-HLA class I antibodies by enzyme-linked immunosorbent assay or lymphocytotoxicity. Results of a blinded, controlled multicenter study. Hum Immunol. 1995;44:1–11. doi: 10.1016/0198-8859(95)00057-B. PubMed DOI

CALLEMEYN J, LERUT E, DE LOOR H, ARIJS I, THAUNAT O, KOENIG A, MEAS-YEDID V, OLIVO-MARIN JC, HALLORAN P, CHANG J, THORREZ L, KUYPERS D, SPRANGERS B, VAN LOMMEL L, SCHUIT F, ESSIG M, GWINNER W, ANGLICHEAU D, MARQUET P, NAESENS M. Transcriptional changes in kidney allografts with histology of antibody-mediated rejection without anti-HLA donor-specific antibodies. J Am Soc Nephrol. 2020;31:2168–2183. doi: 10.1681/ASN.2020030306. PubMed DOI PMC

CHARREAU B. Cellular and molecular crosstalk of graft endothelial cells during amr: effector functions and mechanisms. Transplantation online ahead of print. 2021 doi: 10.1097/TP.0000000000003741. PubMed DOI

DELVILLE M, LAMARTHÉE B, PAGIE S, SEE SB, RABANT M, BURGER C, GATAULT P, GIRAL M, THAUNAT O, ARZOUK N, HERTIG A, HAZZAN M, MATIGNON M, MARIAT C, CAILLARD S, KAMAR N, SAYEGH J, WESTEEL PF, GARROUSTE C, LADRIÈRE M, VUIBLET V, RIVALAN J, MERVILLE P, BERTRAND D, LE MOINE A, DUONG VAN HUYEN JP, CESBRON A, CAGNARD N, ALIBEU O, SATCHELL SC, LEGENDRE C, ZORN E, TAUPIN JL, CHARREAU B, ANGLICHEAU D. Early acute microvascular kidney transplant rejection in the absence of anti-HLA antibodies is associated with preformed IgG antibodies against diverse glomerular endothelial cell antigens. J Am Soc Nephrol. 2019;30:692–709. doi: 10.1681/ASN.2018080868. PubMed DOI PMC

de MENEZES NEVES PD, MACHADO JR, DOS REIS MA, FALEIROS AC, DE LIMA PEREIRA SA, RODRIGUES DB. Distinct expression of interleukin 17, tumor necrosis factor α, transforming growth factor β, and forkhead box P3 in acute rejection after kidney transplantation. Ann Diagn Pathol. 2013;17:75–79. doi: 10.1016/j.anndiagpath.2012.08.002. PubMed DOI

de SOUZA L, PRUNSTER J, CHAN D, CHAKERA A, LIM WH. Recurrent glomerulonephritis after kidney transplantation: a practical approach. Curr Opin Organ Transplant. 2021;26:360–380. doi: 10.1097/MOT.0000000000000887. PubMed DOI

DJAMALI A, KAUFMAN DB, ELLIS TM, ZHONG W, MATAS A, SAMANIEGO M. Diagnosis and management of antibody-mediated rejection: current status and novel approaches. Am J Transplant. 2014;14:255–271. doi: 10.1111/ajt.12589. PubMed DOI PMC

DOMINY KM, WILLICOMBE M, AL JOHANI T, BECKWITH H, GOODALL D, BROOKES P, COOK HT, CAIRNS T, MCLEAN A, ROUFOSSE C. Molecular assessment of C4d-positive renal transplant biopsies without evidence of rejection. Kidney Int Rep. 2018;4:148–158. doi: 10.1016/j.ekir.2018.09.005. PubMed DOI PMC

DRAGUN D, MÜLLER DN, BRÄSEN JH, FRITSCHE L, NIEMINEN-KELHÄ M, DECHEND R, KINTSCHER U, RUDOLPH B, HOEBEKE J, ECKERT D, MAZAK I, PLEHM R, SCHÖNEMANN C, UNGER T, BUDDE K, NEUMAYER HH, LUFT FC, WALLUKAT G. Angiotensin II type 1-receptor activating antibodies in renal-allograft rejection. N Engl J Med. 2005;352:558–569. doi: 10.1056/NEJMoa035717. PubMed DOI

FICHTNER A, SÜSAL C, HÖCKER B, RIEGER S, WALDHERR R, WESTHOFF JH, SANDER A, DRAGUN D, TÖNSHOFF B. Association of non-HLA antibodies against endothelial targets and donor-specific HLA antibodies with antibody-mediated rejection and graft function in pediatric kidney transplant recipients. Pediatr Nephrol. 2021;36:2473–2484. doi: 10.1007/s00467-021-04969-1. PubMed DOI PMC

GARG N, SAMANIEGO MD, CLARK D, DJAMALI A. Defining the phenotype of antibody-mediated rejection in kidney transplantation: Advances in diagnosis of antibody injury. Transplant Rev (Orlando) 2017;31:257–267. doi: 10.1016/j.trre.2017.08.005. PubMed DOI

GIELIS EM, ANHOLTS JDH, VAN BEELEN E, HAASNOOT GW, DE FIJTER HW, BAJEMA I, HEIDT S, VAN DE VRIE M, HILBRANDS LB, MALLAT MJK, LEDEGANCK KJ, CLAAS FHJ, EIKMANS M. A combined microRNA and chemokine profile in urine to identify rejection after kidney transplantation. Transplant Direct. 2021;7:e711. doi: 10.1097/TXD.0000000000001169. PubMed DOI PMC

GOPLANI KR, VANIKAR AV, SHAH PR, GUMBER M, FEROZ A, PATEL HV, KASAT P, FALODIA J, SABOO D, KASWAAN K, GEERISH MS, PANDYA T, TRIVEDI HL. Postrenal transplant hemolytic uremic syndrome/thrombotic microangiopathy: Ahmedabad experience. Transplant Proc. 2008;40:1114–1116. doi: 10.1016/j.transproceed.2008.03.028. PubMed DOI

GOYTAIN A, NG T. NanoString nCounter Technology: High-Throughput RNA Validation. Methods Mol Biol. 2020;2079:125–139. doi: 10.1007/978-1-4939-9904-0_10. PubMed DOI

GUPTA G, MOINUDDIN I, KAMAL L, KING AL, WINSTEAD R, DEMEHIN M, KANG L, KIMBALL P, LEVY M, BHATI C, MASSEY HD, KUMAR D, HALLORAN PF. Correlation of Donor-Derived Cell-free DNA with Histology and Molecular Diagnoses of Kidney Transplant Biopsies. Transplantation online ahead of print. 2021 doi: 10.1097/TP.0000000000003838. PubMed DOI

HAAS M, LOUPY A, LEFAUCHEUR C, ROUFOSSE C, GLOTZ D, SERON D, NANKIVELL BJ, HALLORAN PF, COLVIN RB, AKALIN E, ALACHKAR N, BAGNASCO S, BOUATOU Y, BECKER JU, CORNELL LD, DUONG VAN HUYEN JP, GIBSON IW, KRAUS ES, MANNON RB, NAESENS M, NICKELEIT V, NICKERSON P, SEGEV DL, SINGH HK, STEGALL M, RANDHAWA P, RACUSEN L, SOLEZ K, MENGEL M. The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018;18:293–307. doi: 10.1111/ajt.14625. PubMed DOI PMC

HAAS M, SIS B, RACUSEN LC, SOLEZ K, GLOTZ D, COLVIN RB, CASTRO MC, DAVID DS, DAVID-NETO E, BAGNASCO SM, CENDALES LC, CORNELL LD, DEMETRIS AJ, DRACHENBERG CB, FARVER CF, FARRIS AB, 3RD, GIBSON IW, KRAUS E, LIAPIS H, LOUPY A, NICKELEIT V, RANDHAWA P, RODRIGUEZ ER, RUSH D, SMITH RN, TAN CD, WALLACE WD, MENGEL M Banff meeting report writing committee. Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant. 2014;14:272–83. doi: 10.1111/ajt.12590. PubMed DOI

HARA S. Cell mediated rejection revisited: Past, current, and future directions. Nephrology (Carlton) 23 Suppl. 2018;2:45–51. doi: 10.1111/nep.13283. PubMed DOI

HALLORAN PF, PEREIRA AB, CHANG J, MATAS A, PICTON M, DE FREITAS D, BROMBERG J, SERÓN D, SELLARÉS J, EINECKE G, REEVE J. Microarray diagnosis of antibody-mediated rejection in kidney transplant biopsies: an international prospective study (INTERCOM) Am J Transplant. 2013;13:2865–2874. doi: 10.1111/ajt.12465. PubMed DOI

HALLORAN PF, REEVE J, AKALIN E, AUBERT O, BOHMIG GA, BRENNAN D, BROMBERG J, EINECKE G, ESKANDARY F, GOSSET C, DUONG VAN HUYEN JP, GUPTA G, LEFAUCHEUR C, MALONE A, MANNON RB, SERON D, SELLARES J, WEIR M, LOUPY A. Real Time Central Assessment of Kidney Transplant Indication Biopsies by Microarrays: The INTERCOMEX Study. Am J Transplant. 2017;17:2851–2862. doi: 10.1111/ajt.14329. PubMed DOI

HEIDT S, HAASNOOT GW, CLAAS FHJ. How the definition of acceptable antigens and epitope analysis can facilitate transplantation of highly sensitized patients with excellent long-term graft survival. Curr Opin Organ Transplant. 2018;23:493–499. doi: 10.1097/MOT.0000000000000545. PubMed DOI

HRUBA P, KREJCIK Z, STRANECKY V, MALUSKOVA J, SLATINSKA J, GUELER F, GWINNER W, BRÄSEN JH, WOHLFAHRTOVA M, PARIKOVA A, OSICKOVA K, FRONEK J, SEDA O, PREFERTUSOVA L, HONSOVA E, VIKLICKY O. Molecular Patterns Discriminate Accommodation and Subclinical Antibody-mediated Rejection in Kidney Transplantation. Transplantation. 2019;103:909–917. doi: 10.1097/TP.0000000000002604. PubMed DOI

KOENIG A, CHEN CC, MARÇAIS A, BARBA T, MATHIAS V, SICARD A, RABEYRIN M, RACAPÉ M, DUONG-VAN-HUYEN JP, BRUNEVAL P, LOUPY A, DUSSURGEY S, DUCREUX S, MEAS-YEDID V, OLIVO-MARIN JC, PAIDASSI H, GUILLEMAIN R, TAUPIN JL, CALLEMEYN J, MORELON E, NICOLETTI A, CHARREAU B, DUBOIS V, NAESENS M, WALZER T, DEFRANCE T, THAUNAT O. Missing self triggers NK cell-mediated chronic vascular rejection of solid organ transplants. Nat Commun. 2019;10:5350. doi: 10.1038/s41467-019-13113-5. PubMed DOI PMC

KOENIG A, MEZAACHE S, CALLEMEYN J, BARBA T, MATHIAS V, SICARD A, CHARREAU B, RABEYRIN M, DIJOUD F, PICARD C, MEAS-YEDID V, OLIVO-MARIN JC, MORELON E, NAESENS M, DUBOIS V, THAUNAT O. Missing self-induced activation of nk cells combines with non-complement-fixing donor-specific antibodies to accelerate kidney transplant loss in chronic antibody-mediated rejection. J Am Soc Nephrol. 2021;32:479–494. doi: 10.1681/ASN.2020040433. PubMed DOI PMC

KRAMER A, BOENINK R, STEL VS, SANTIUSTE DE PABLOS C, TOMOVIĆ F, GOLAN E, KERSCHBAUM J, SEYAHI N, IOANOU K, BELTRÁN P, ZURRIAGA O, MAGAZ Á, SLON ROBLERO MF, GJORGJIEVSKI N, GARNEATA L, ARRIBAS F, GALVÃO AA, BELL S, OTS-ROSENBERG M, MUÑOZ-TEROL JM, WINZELER R, HOMMEL K, ÅSBERG A, SPUSTOVA V, PALENCIA GARCÍA MÁ, VAZELOV E, FINNE P, TEN DAM MAGJ, LOPOT F, TRUJILLO-ALEMÁN S, LASSALLE M, KOLESNYK MO, SANTHAKUMARAN S, IDRIZI A, ANDRUSEV A, COMAS FARNÉS J, KOMISSAROV K, RESIĆ H, PALSSON R, KUZEMA V, GARCIA BAZAGA MA, ZIGINSKIENE E, STENDAHL M, BONTHUIS M, MASSY ZA, JAGER KJ. The ERA-EDTA Registry Annual Report 2018: A summary. Clin Kidney J. 2020;14:107–123. doi: 10.1093/ckj/sfaa271. PubMed DOI PMC

LECHEVALLIER E, DUSSOL B, LUCCIONI A, THIRION X, VACHER-COPOMAT H, JABER K, BRUNET P, LEONETTI F, LAVELLE O, COULANGE C, BERLAND Y. Posttransplantation acute tubular necrosis: risk factors and implications for graft survival. Am J Kidney Dis. 1998;32:984–991. doi: 10.1016/S0272-6386(98)70073-3. PubMed DOI

LEFAUCHEUR C, LOUPY A, VERNEREY D, DUONG-VAN-HUYEN JP, SUBERBIELLE C, ANGLICHEAU D, VÉRINE J, BEUSCART T, NOCHY D, BRUNEVAL P, CHARRON D, DELAHOUSSE M, EMPANA JP, HILL GS, GLOTZ D, LEGENDRE C, JOUVEN X. Antibody-mediated vascular rejection of kidney allografts: a population-based study. Lancet. 2013;381:313–319. doi: 10.1016/S0140-6736(12)61265-3. PubMed DOI

LEFAUCHEUR C, VIGLIETTI D, BOUATOU Y, PHILIPPE A, PIEVANI D, AUBERT O, DUONG VAN HUYEN JP, TAUPIN JL, GLOTZ D, LEGENDRE C, LOUPY A, HALLORAN PF, DRAGUN D. Non-HLA agonistic anti-angiotensin II type 1 receptor antibodies induce a distinctive phenotype of antibody-mediated rejection in kidney transplant recipients. Kidney Int. 2019;96:189–201. doi: 10.1016/j.kint.2019.01.030. PubMed DOI

LIPMAN ML, STEVENS AC, BLEACKLEY RC, HELDERMAN JH, MCCUNE TR, HARMON WE, SHAPIRO ME, ROSEN S, STROM TB. The strong correlation of cytotoxic T lymphocyte-specific serine protease gene transcripts with renal allograft rejection. Transplantation. 1992;53:73–79. doi: 10.1097/00007890-199201000-00014. PubMed DOI

LOUPY A, HAAS M, ROUFOSSE C, NAESENS M, ADAM B, AFROUZIAN M, AKALIN E, ALACHKAR N, BAGNASCO S, BECKER JU, CORNELL LD, CLAHSEN-VAN GRONINGEN MC, DEMETRIS AJ, DRAGUN D, DUONG VAN HUYEN JP, FARRIS AB, FOGO AB, GIBSON IW, GLOTZ D, GUEGUEN J, KIKIC Z, KOZAKOWSKI N, KRAUS E, LEFAUCHEUR C, LIAPIS H, MANNON RB, MONTGOMERY RA, NANKIVELL BJ, NICKELEIT V, NICKERSON P, RABANT M, RACUSEN L, RANDHAWA P, ROBIN B, ROSALES IA, SAPIR-PICHHADZE R, SCHINSTOCK CA, SERON D, SINGH HK, SMITH RN, STEGALL MD, ZEEVI A, SOLEZ K, COLVIN RB, MENGEL M. The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell- and antibody-mediated rejection. Am J Transplant. 2020;20:2318–2331. doi: 10.1111/ajt.15898. PubMed DOI PMC

LOUPY A, HAAS M, SOLEZ K, RACUSEN L, GLOTZ D, SERON D, NANKIVELL BJ, COLVIN RB, AFROUZIAN M, AKALIN E, ALACHKAR N, BAGNASCO S, BECKER JU, CORNELL L, DRACHENBERG C, DRAGUN D, DE KORT H, GIBSON IW, KRAUS ES, LEFAUCHEUR C, LEGENDRE C, LIAPIS H, MUTHUKUMAR T, NICKELEIT V, ORANDI B, PARK W, RABANT M, RANDHAWA P, REED EF, ROUFOSSE C, SESHAN SV, SIS B, SINGH HK, SCHINSTOCK C, TAMBUR A, ZEEVI A, MENGEL M. The Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology. m J Transplant. 2017;17:28–41. doi: 10.1111/ajt.14107. PubMed DOI PMC

LOUPY A, LEFAUCHEUR C, VERNEREY D, PRUGGER C, DUONG VAN HUYEN JP, MOONEY N, SUBERBIELLE C, FRÉMEAUX-BACCHI V, MÉJEAN A, DESGRANDCHAMPS F, ANGLICHEAU D, NOCHY D, CHARRON D, EMPANA JP, DELAHOUSSE M, LEGENDRE C, GLOTZ D, HILL GS, ZEEVI A, JOUVEN X. Complement-binding anti-HLA antibodies and kidney-allograft survival. N Engl J Med. 2013;369:1215–1226. doi: 10.1056/NEJMoa1302506. PubMed DOI

LUQUE S, LÚCIA M, MELILLI E, LEFAUCHEUR C, CRESPO M, LOUPY A, BERNAL-CASAS D, GOMÀ M, JARQUE M, CRESPO E, MONTERO N, MANONELLES A, CRUZADO JM, GIL-VERNET S, GRINYÓ JM, BESTARD O. Value of monitoring circulating donor-reactive memory B cells to characterize antibody-mediated rejection after kidney transplantation. Am J Transplant. 2019;19:368–380. doi: 10.1111/ajt.15055. PubMed DOI

MADILL-THOMSEN KS, PERKOWSKA-PTASIŃSKA A, BÖHMIG GA, ESKANDARY F, EINECKE G, GUPTA G, HALLORAN PF MMDx-Kidney Study Group. Discrepancy analysis comparing molecular and histology diagnoses in kidney transplant biopsies. Am J Transplant. 2020;20:1341–1350. doi: 10.1111/ajt.15752. PubMed DOI

MADILL-THOMSEN KS, WIGGINS RC, ESKANDARY F, BÖHMIG GA, HALLORAN PF. The Effect of Cortex/Medulla Proportions on Molecular Diagnoses in Kidney Transplant Biopsies: Rejection and Injury Can Be Assessed in Medulla. Am J Transplant. 2017;17:2117–2128. doi: 10.1111/ajt.14233. PubMed DOI PMC

MAUIYYEDI S, CRESPO M, COLLINS AB, SCHNEEBERGER EE, PASCUAL MA, SAIDMAN SL, TOLKOFF-RUBIN NE, WILLIAMS WW, DELMONICO FL, COSIMI AB, COLVIN RB. Acute humoral rejection in kidney transplantation: II. Morphology, immunopathology, and pathologic classification. J Am Soc Nephrol. 2002;13:779–787. doi: 10.1681/ASN.V133779. PubMed DOI

MENGEL M, LOUPY A, HAAS M, ROUFOSSE C, NAESENS M, AKALIN E, CLAHSEN-VAN GRONINGEN MC, DAGOBERT J, DEMETRIS AJ, DUONG VAN HUYEN JP, GUEGUEN J, ISSA F, ROBIN B, ROSALES I, VON DER THÜSEN JH, SANCHEZ-FUEYO A, SMITH RN, WOOD K, ADAM B, COLVIN RB. Banff 2019 Meeting Report: Molecular diagnostics in solid organ transplantation-Consensus for the Banff Human Organ Transplant (B-HOT) gene panel and open source multicenter validation. Am J Transplant. 2020;20:2305–2317. doi: 10.1111/ajt.16059. PubMed DOI PMC

MENGEL M, SIS B, HAAS M, COLVIN RB, HALLORAN PF, RACUSEN LC, SOLEZ K, CENDALES L, DEMETRIS AJ, DRACHENBERG CB, FARVER CF, RODRIGUEZ ER, WALLACE WD, GLOTZ D Banff meeting report writing committee. Banff 2011 Meeting report: new concepts in antibody-mediated rejection. Am J Transplant. 2012;12:563–570. doi: 10.1111/j.1600-6143.2011.03926.x. PubMed DOI PMC

MOHAMMED MT, CAI S, HANSON BL, ZHANG H, CLEMENT RL, DACCACHE J, CAVAZZONI CB, BLAZAR BR, ALESSANDRINI A, RENNKE HG, CHANDRAKER A, SAGE PT. Follicular T cells mediate donor-specific antibody and rejection after solid organ transplantation. Am J Transplant. 2021;21:1893–1901. doi: 10.1111/ajt.16484. PubMed DOI PMC

MORETTA A, BOTTINO C, PENDE D, TRIPODI G, TAMBUSSI G, VIALE O, ORENGO A, BARBARESI M, MERLI A, CICCONE E. Identification of four subsets of human CD3-CD16+ natural killer (NK) cells by the expression of clonally distributed functional surface molecules: correlation between subset assignment of NK clones and ability to mediate specific alloantigen recognition. J Exp Med. 1990;172:1589–98. doi: 10.1084/jem.172.6.1589. PubMed DOI PMC

MUMFORD L, FUGGLE SV, MARTORELL J, SLAVCEV A, INIOTAKI A, HAASNOOT GW, HEIDT S, CLAAS FHJ. A Europe wide acceptable mismatch program will enable transplantation of long waiting highly sensitised patients with a compatible donor. ranspl Immunol. 2021;64:101354. doi: 10.1016/j.trim.2020.101354. PubMed DOI

NELSON PW, ESCHLIMAN P, SHIELD CF, AEDER MI, LUGER AM, PIERCE GE, BRYAN CF. Improved graft survival in cadaveric renal retransplantation by flow crossmatching. Arch Surg. 1996;131:599–603. doi: 10.1001/archsurg.1996.01430180025004. PubMed DOI

NOVOTNY M, HRUBA P, VICHOVA P, MALUSKOVA J, HONSOVA E, VIKLICKY O, WOHLFAHRTOVA M. Isolated v-lesion represents a benign phenotype of vascular rejection of the kidney allograft - a retrospective study. Transpl Int. 2018;31:1153–1163. doi: 10.1111/tri.13286. PubMed DOI

OHLÉN C, KLING G, HÖGLUND P, HANSSON M, SCANGOS G, BIEBERICH C, JAY G, KÄRRE K. Prevention of allogeneic bone marrow graft rejection by H-2 transgene in donor mice. Science. 1989;246:666–8. doi: 10.1126/science.2814488. PubMed DOI

PARAJULI S, AZIZ F, GARG N, PANZER SE, JOACHIM E, MUTH B, MOHAMED M, BLAZEL J, ZHONG W, ASTOR BC, MANDELBROT DA, DJAMALI A. Histopathological characteristics and causes of kidney graft failure in the current era of immunosuppression. World J Transplant. 2019;9:123–133. doi: 10.5500/wjt.v9.i6.123. PubMed DOI PMC

PERNIN V, BEYZE A, SZWARC I, BEC N, SALSAC C, PEREZ-GARCIA E, MOURAD G, MERVILLE P, VISENTIN J, PERROCHIA H, LARROQUE C, COUZI L, LE QUINTREC M. Distribution of de novo donor-specific antibody subclasses quantified by mass spectrometry: high IgG3 proportion is associated with antibody-mediated rejection occurrence and severity. Front Immunol. 2020;11:919. doi: 10.3389/fimmu.2020.00919. PubMed DOI PMC

RACUSEN LC, COLVIN RB, SOLEZ K, MIHATSCH MJ, HALLORAN PF, CAMPBELL PM, CECKA MJ, COSYNS JP, DEMETRIS AJ, FISHBEIN MC, FOGO A, FURNESS P, GIBSON IW, GLOTZ D, HAYRY P, HUNSICKERN L, KASHGARIAN M, KERMAN R, MAGIL AJ, MONTGOMERY R, MOROZUMI K, NICKELEIT V, RANDHAWA P, REGELE H, SERON D, SESHAN S, SUND S, TRPKOV K. Antibody-mediated rejection criteria - an addition to the Banff 97 classification of renal allograft rejection. Am J Transplant. 2003;3:708–14. doi: 10.1034/j.1600-6143.2003.00072.x. PubMed DOI

REGELE H, EXNER M, WATSCHINGER B, WENTER C, WAHRMANN M, OSTERREICHER C, SÄEMANN MD, MERSICH N, HÖRL WH, ZLABINGER GJ, BÖHMIG GA. Endothelial C4d deposition is associated with inferior kidney allograft outcome independently of cellular rejection. Nephrol Dial Transplant. 2001;16:2058–66. doi: 10.1093/ndt/16.10.2058. PubMed DOI

REINDL-SCHWAIGHOFER R, HEINZEL A, KAINZ A, VAN SETTEN J, JELENCSICS K, HU K, LOZA BL, KAMMER M, HEINZE G, HRUBA P, KONARIKOVA A, VIKLICKY O, BOEHMIG GA, ESKANDARY F, FISCHER G, CLAAS F, TAN JC, ALBERT TJ, PATEL J, KEATING B, OBERBAUER R iGeneTRAiN consortium. Contribution of non-HLA incompatibility between donor and recipient to kidney allograft survival: genome-wide analysis in a prospective cohort. Lancet. 2019;393:910–917. doi: 10.1016/S0140-6736(18)32473-5. PubMed DOI

REMUZZI G, BERTANI T. Renal vascular and thrombotic effects of cyclosporine. Am J Kidney Dis. 1989;13:261–272. doi: 10.1016/S0272-6386(89)80032-0. PubMed DOI

SCHINSTOCK CA, ASKAR M, BAGNASCO SM, BATAL I, BOW L, BUDDE K, CAMPBELL P, CARROLL R, CLAHSEN-VAN GRONINGEN MC, COOPER M, CORNELL LD, COZZI E, DADHANIA D, DIEKMANN F, HESSELINK DA, JACKSON AM, KIKIC Z, LOWER F, NAESENS M, ROELOFS JJ, SAPIR-PICHHADZE R, KRAUS ES. A 2020 Banff Antibody-mediated Injury Working Group examination of international practices for diagnosing antibody-mediated rejection in kidney transplantation - a cohort study. Transpl Int. 2021;34:488–498. doi: 10.1111/tri.13813. PubMed DOI

SENEV A, COEMANS M, LERUT E, VAN SANDT V, DANIËLS L, KUYPERS D, SPRANGERS B, EMONDS MP, NAESENS M. Histological picture of antibody-mediated rejection without donor-specific anti-HLA antibodies: Clinical presentation and implications for outcome. Am J Transplant. 2019;19:763–780. doi: 10.1111/ajt.15074. PubMed DOI

SOLEZ K, AXELSEN RA, BENEDIKTSSON H, BURDICK JF, COHEN AH, COLVIN RB, CROKER BP, DROZ D, DUNNILL MS, HALLORAN PF. International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int. 1993;44:411–422. doi: 10.1038/ki.1993.259. PubMed DOI

WOHLFAHRTOVA M, HRUBA P, KLEMA J, NOVOTNY M, KREJCIK Z, STRANECKY V, HONSOVA E, VICHOVA P, VIKLICKY O. Early isolated V-lesion may not truly represent rejection of the kidney allograft. Clin Sci (Lond) 2018;132:2269–2284. doi: 10.1042/CS20180745. PubMed DOI PMC

ZHANG R. Donor-Specific Antibodies in Kidney Transplant Recipients. Clin J Am Soc Nephrol. 2018;13:182–192. doi: 10.2215/CJN.00700117. PubMed DOI PMC