{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:27:50Z","timestamp":1793831270507,"version":"4.6.1"},"reference-count":82,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Antibody-mediated rejection (AMR) remains a major cause of graft failure, with significant health and economic burden. Despite being recognized &amp;gt;25 years ago, AMR treatment remains unstandardized, and no therapy has gained robust regulatory approval. While uncontrolled series have shown promise, few well-designed trials exist, with most yielding negative results. In the absence of strong trial data, a Transplantation Society expert consensus recommended potential treatment options with low levels of evidence, tailored to clinical phenotypes. Here, we re-evaluate the current evidence for AMR treatment decisions. We conclude that steroids, rituximab, bortezomib, and interleukin-6 (IL-6) antagonists lack sufficiently robust evidence to support their use in AMR. For early AMR, antibody depletion using immunoadsorption could be considered as an alternative to plasmapheresis. High-dose intravenous immunoglobulin (IVIG) may be added, though the supporting evidence remains limited. While previous trials primarily targeted the cause of AMR, recent data on the successful reversal of AMR activity by CD38 antibodies\u2014particularly recent phase 2 trial results\u2014suggest that targeting the cellular inflammation resulting from antibody binding to the endothelium could be a rational approach. Along these lines, in severe early AMR, complement inhibition may also be an option. Ongoing phase 2 trials evaluating prolonged courses of high-dose IVIG, the neonatal Fc receptor blocker efgartigimod, the tyrosine kinase inhibitor fostamatinib, and the complement inhibitor BIVV020, along with phase 3 trials of the anti-IL-6 receptor antibody tocilizumab and the CD38 antibody felzartamab, offer hope for effective, approved therapies targeting different aspects of AMR pathobiology.<\/jats:p>","DOI":"10.1093\/ndt\/gfaf097","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T12:53:42Z","timestamp":1748523222000},"page":"1615-1627","source":"Crossref","is-referenced-by-count":43,"title":["Antibody-mediated rejection\u2014treatment standard"],"prefix":"10.1093","volume":"40","author":[{"given":"Georg A","family":"B\u00f6hmig","sequence":"first","affiliation":[{"name":"Medical University of Vienna Division of Nephrology and Dialysis, Department of Medicine III, , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Naesens","sequence":"additional","affiliation":[{"name":"Immunology and Transplantation, KU Leuven Department of Microbiology, , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ondrej","family":"Viklicky","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Department of Nephrology, , Prague ,","place":["Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Thaunat","sequence":"additional","affiliation":[{"name":"Service de N\u00e9phrologie, H\u00e9modialyse, Aph\u00e9r\u00e8ses et Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6914-9132","authenticated-orcid":false,"given":"Matthias","family":"Diebold","sequence":"additional","affiliation":[{"name":"Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5130-7286","authenticated-orcid":false,"given":"Lionel","family":"Rostaing","sequence":"additional","affiliation":[{"name":"Nephrology and Clinical Immunology, Edouard Herriot Hospital Department of Transplantation, , Hospices Civils de Lyon, Lyon ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7929-5942","authenticated-orcid":false,"given":"Klemens","family":"Budde","sequence":"additional","affiliation":[{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin Department of Nephrology, , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"2025080112221290300_bib1","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.kint.2021.11.029","article-title":"Allorecognition and the spectrum of kidney transplant rejection","volume":"101","author":"Callemeyn","year":"2022","journal-title":"Kidney Int"},{"key":"2025080112221290300_bib2","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1097\/TP.0000000000004550","article-title":"On a long and winding road: alloantibodies in organ transplantation","volume":"107","author":"B\u00f6hmig","year":"2023","journal-title":"Transplantation"},{"key":"2025080112221290300_bib3","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1097\/TP.0000000000003095","article-title":"Recommended treatment for antibody-mediated rejection after kidney transplantation: the 2019 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