**9. Summary**

Immunologic barriers once considered insurmountable are now consistently overcome to enable more patients to undergo organ transplantation. Alloantibodies are a substantial obstacle to short- and long-term graft survival. To prevent or reduce alloantibody titres, more insights are needed to improve our understanding of the regulation of B cells and the devel‐ opmental and differentiation pathways of memory B cells and plasma cells.

Several important issues regarding AMR remain. First, the immunologic mechanisms respon‐ sible for the development of high levels of DSA are still unclear. The contribution of memory B cells versus the role of pre-existing PCs has important therapeutic implications since each may have a differential sensitivity to various agents.

Whereas several new therapeutic approaches have emerged, more extensive study and followup are needed to determine if these apparent advances will improve the outcomes of AMR.
