Antibody-mediated rejection (ABMR) is a serious problem for kidney allografts. While T cell-mediated rejection (TCMR) can be treated effectively with immunosuppressive drugs, ABMR tends to be more refractory to treatment. On diagnostic front, there is a lack of test with sufficient sensitivity and specificity. Diagnostic criteria for ABMR was set by Banff include histologic changes, C4d in graft and donor specific antibody (DSA). The criteria have been proven to be too rigid with the increasingly-recognized C4d negative ABMR.
