Trends in Nephrology: From nihilism to targeted treatment of antibody-mediated rejection

State-of-the-field review of AbMR therapy. IL-6 blockade failed a phase 3 trial; anti-CD20 has not improved graft survival; imlifidase showed a HIGHER rate of graft loss in the experimental arm of an AbMR study; terminal complement inhibitors were inconsistent in underpowered trials, with C3 inhibition now the more promising complement target. Anti-CD38 antibodies currently carry the strongest evidence. Also discusses CD38-knockout multitarget NK cells with anti-BCMA CAR plus daratumumab as a cheaper, safer alternative to CHAR T cells, and hypothesises bispecific T-cell engagers.