Non-HLA antibodies in kidney allograft rejection: convincing concept in need of further evidence

Mostly indirect evidence suggests an important pathogenic role for non-HLA anti-endothelial cell antibodies (AECAs) in both acute and chronic rejection. The lack of standardized screening assays for AECAs unfortunately hampers the systematic collection of data in multicenter trials. Diagnostic tests based on commercially available platforms could pave the way for testing larger patient cohorts, but they still suffer from some important limitations.