{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:04:17Z","timestamp":1789733057998,"version":"4.0.1"},"reference-count":101,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Antibody-mediated rejection (AMR) remains a major obstacle to long-term kidney allograft survival. It does not arise from a single pathway. Preformed or\n                    <jats:italic>de novo<\/jats:italic>\n                    donor-specific antibodies (DSA), endothelial injury, microvascular inflammation, complement-dependent and complement-independent mechanisms, and chronic remodeling may each contribute, often in different combinations. Recent Banff updates, biopsy-based transcriptomics, DSA assessment, and donor-derived cell-free DNA (dd-cfDNA) testing have made AMR phenotypes easier to recognize. Still, these tests are most useful when interpreted together rather than treated as separate answers. The same caution applies to treatment. Plasma exchange, intravenous immunoglobulin, B-cell or plasma-cell directed agents, complement inhibition, IL-6 pathway blockade, and optimization of maintenance immunosuppression differ in the strength of their evidence, the patients they may help, their toxicities, and their feasibility in routine practice. This review summarizes current concepts in AMR pathogenesis, diagnosis, and emerging therapy, using phenotype-guided assessment to separate expert-consensus practice from randomized evidence, observational experience, and experimental interventions.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1951717","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:26:21Z","timestamp":1789730781000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Advances in antibody-mediated rejection of renal allografts"],"prefix":"10.3389","volume":"17","author":[{"given":"Bin","family":"Song","sequence":"first","affiliation":[{"name":"Linyi Health School of Shandong Province","place":["Linyi, China"]},{"name":"Department of Andrology, Linyi People\u2019s Hospital","place":["Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Renal Transplantation, Linyi People\u2019s Hospital","place":["Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Hu","sequence":"additional","affiliation":[{"name":"Institute of Transplantation Medicine, The Second Affiliated Hospital of Guangxi Medical University, Guangxi Clinical Research Center for Organ Transplantation, Guangxi Key Laboratory of Organ Donation and Transplantation","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuyang","family":"Liu","sequence":"additional","affiliation":[{"name":"Institute of Transplantation Medicine, The Second Affiliated Hospital of Guangxi Medical University, Guangxi Clinical Research Center for Organ Transplantation, Guangxi Key Laboratory of Organ Donation and Transplantation","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant","author":"Wolfe","year":"1999","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1802677","article-title":"Antibody-mediated rejection of solid-organ allografts","author":"Loupy","year":"2018","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03840.x","article-title":"Understanding the causes of kidney transplant failure: The dominant role of antibody-mediated rejection and nonadherence","author":"Sellar\u00e9s","year":"2012","journal-title":"Am J 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