**7. Conclusion**

Significant progress has occurred in the understanding of ABMR. Diagnosis, classification and treatment of this process have evolved greatly. However, standardisation of diagnostic tests (DSA-testing), and development of evidence-based treatment guidelines is still lacking. Currently, protocols are individualised among different centres and based largely on anecdotal and/or local experience. ABOI and HLA desensitisation protocols (not detailed in this chapter) also need to gain excellent long term results to justify the tremendous cost involved in order to reduce the growing number of sensitised potential recipients on the waiting list. Paired donor exchange programs, although fraught with major logistic as well as some ethical and occasionally legal concerns, may be part of the solution to provide allografts to some of these difficult-to-transplant individuals in order to improve their quality and quantity of life. Such recipients, after successful transplantation, will be at increased risk of ABMR and will need good monitoring and treatment strategies to enable successful long-term outcomes.
