Morphologic aspects of antibody-mediated rejection in renal allografts

Recent studies have illustrated the important role of alloantibodies in mediating renal allograft rejection. Compared to T-cell mediated-rejection, antibody-mediated rejection is usually more refractory to conventional anti-rejection treatment and more likely to contribute to allograft failure. Antibody-mediated rejection can occur in three principal forms: hyperacute, acute, and chronic active. This brief review aims to characterize the main pathological features attributed to antibody-mediated rejection including light microscopy manifestations, ultrastructural alterations, and immunopathologic markers.