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This may result in an increased rate of transplantation from HLA\u2010mismatched donors that increases the rate of antibody\u2010mediated rejection (AMR), which already is the leading cause of allograft failure. Plasmapheresis, intravenous immunoglobulin therapy, anti\u2010CD20 therapies (i.e., rituximab), bortezomib and splenectomy have been used over the years to treat AMR as well as to prevent AMR in high\u2010risk sensitized kidney transplant recipients. Eculizumab and ravulizumab are monoclonal antibodies targeting the C5 protein of the complement pathway and part of the expanding field of anticomplement therapies, which is not limited to kidney transplant recipients, and also includes complement\u2010mediated microangiopathic hemolytic anemia, paroxysmal nocturnal hemoglobinuria, and ANCA\u2010vasculitis. In this narrative review, we summarize the current knowledge concerning the pathophysiological background and use of anti\u2010C5 strategies (eculizumab and ravulizumab) and C1\u2010esterase inhibitor in AMR, either to prevent AMR in high\u2010risk desensitized patients or to treat AMR as first\u2010line or rescue therapy and also to treat de novo thrombotic microangiopathy in kidney transplant recipients.<\/jats:p>","DOI":"10.1111\/ctr.15277","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T03:29:29Z","timestamp":1710473369000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The role of anticomplement therapy in the management of the kidney allograft"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-0675","authenticated-orcid":false,"given":"Mehmet","family":"Kanbay","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidar","family":"Copur","sequence":"additional","affiliation":[{"name":"Department of Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep Y.","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilek Ertoy","family":"Baydar","sequence":"additional","affiliation":[{"name":"Department of Pathology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilmay","family":"Bilge","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caner","family":"Susal","sequence":"additional","affiliation":[{"name":"Transplant Immunology Research Center of Excellence, Koc University Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Kocak","sequence":"additional","affiliation":[{"name":"Department of Urology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Department of Medicine Universidad Autonoma de Madrid and IIS\u2010Fundacion Jimenez Diaz  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOT.0b013e328354c277"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfab273"},{"issue":"2","key":"e_1_2_13_4_1","first-page":"154","article-title":"The European Renal Association\u2014European Dialysis and Transplant Association Registry Annual Report 2014: a summary","volume":"10","author":"Pippias M","year":"2017","journal-title":"Clin Kidney J"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trre.2013.12.003"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31824db97d"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2021.08.031"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002049"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61265-3"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03283.x"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.12335"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1501686"},{"key":"e_1_2_13_13_1","unstructured":"Agency EM.Summary of product characteristics.2020. 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