**6. Conclusions**

Antibody-mediated rejection is an important cause of acute and chronic graft failure. Diagnosis of acute and chronic ABMR is based on typical histological hallmarks, positive C4d in peritubular capillaries and presence of donor-specific antibodies (DSA). Among standard of care treatment based on PP and IVIG, new treatment options have become available: B cell depletion (rituximab), plasma cell depletion (bortezomib), complement activation inhibition (c1 and c5 inhibitors), recently also IL-6 inhibitors and ideS. However, the high cost of novel medications and a lack of prospective studies evaluating their efficacy and safety limit the routine use of these agents in the treatment of ABMR in kidney transplant recipients.

#### **Conflict of interest**

Authors declare no conflicts of interest.

*Perioperative Care for Organ Transplant Recipient*
