Progress in the field of antibody mediated rejection (ABMR) in kidney transplantation has shown a rapid increase during the past two decades. New pathologic entities have emerged and replace old concepts and diagnostic terms. According to newly acknowledged facts discovered by clinicians, researchers, and pathologists all over the world, an updated classification, rather than Banff 07, is needed. In order to improve the diagnostic accuracy for ABMR in clinicians as well as pathologists, recognition and awareness of various conditions such as C4d-negative ABMR, subclinical ABMR, de novo donor specific antibody, microcirculation inflammation, isolated vascular lesion, antibody-mediated transplant arteriopathy, etc. are essentially important.

Keywords: Antibodies, Graft rejection, Complement C4d, Transplantation, Kidney