title: New insights in antibody-mediated rejection.
abstract: OBJECTIVE
  In the present review, we aim to describe the state of knowledge concerning antibody-mediated rejection (ABMR) spectrum and diagnosis criteria before analyzing the present and future promising leads regarding ABMR prognosis markers and treatment.
  
  
  RESULTS
  Recent studies regarding complement-binding donor-specific antibodies and the molecular approach highlighted the unmet need for stratification tools for prognosis and treatment inside ABMR disease.
  
  
  CONCLUSIONS
  ABMR is the leading cause of kidney allograft failure. The recent expansion of its spectrum is related to the paradigm of a continuous process, leading insidiously to a chronic form of ABMR and to the progressive acknowledgement of new entities (such as vascular ABMR, subclinical ABMR, C4d-negative ABMR). Considering the global picture of ABMR, the Banff classification gradually refined the diagnosis criteria so that it now describes a clinically relevant and coherent entity. Nevertheless, if the diagnosis mainly relies on conventional assessment, such as histological findings and circulating donor-specific antibodies, these criteria face serious limitations in terms of stratification of patients at risk of graft loss inside ABMR disease. Recently, new promising tools have emerged in order to identify long-term outcomes at the time of the diagnosis of rejection. In this regard, donor-specific antibodies' complement-fixing ability and the molecular approach contributed significantly. Currently, however, no clinically relevant surrogate marker of treatment efficiency is currently available.
authors.affiliation: aNephrology and Kidney Transplantation bINSERM U 1160 cLabEx TRANSPLANTEX, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France dUniversité Paris Diderot 7, Paris, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Gosset
authors.forename: Carmen
authors.initials: C
authors.lastname: Lefaucheur
authors.forename: Denis
authors.initials: D
authors.lastname: Glotz
mesh_terms: D000818:Animals; D001706:Biopsy; D003165:Complement System Proteins / Q000276:immunology; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology*; D006085:Graft Survival; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D007668:Kidney / Q000276:immunology* / Q000473:pathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007518:Isoantibodies; D003165:Complement System Proteins