Summary: Antibody mediated rejection is a leading cause of late renal allograft loss. Donor specific antibodies are associated with endothelial cells injury and microvascular inflammation. Management of active and chronic active ABMR is focused on humoral response to alloantigens. Target therapies included: costimulation signals, depletion of B lymphocytes or plasmacytes, complement cascade, DSA elimination. In article treatment with plasmapheresis, IVIG, rituximab, bortezomib, eculizumab, costimulation blockade, anti-IL-6 antibodies were discussed. Currently, there are no approved treatments for acute or chronic AMR. Treatment recommendations are largely based on observational studies, case series reports and expert opinion. Clinical trials are urgently needed.