TABLE 2.

Summary of statements and recommendations.

Recommendations	GRADE level	W&J criterium
Efforts should be made to prevent late renal allograft loss, of which one of the leading causes is ABMR.	1A	1
Clinicians should note that DSA are associated with a high risk of rejection, primarily ABMR, and subsequent allograft loss	1A	2
DSA can signal for underlying microscopic injury, indicative of subclinical rejection (ABMR and TCMR), which can be identified through allograft biopsy	1C	3
Upon detection of de novo DSA, the pathogenicity and the impact on prognosis is currently best assessed by doing a biopsy	1C	3
Efforts should be made to standardize testing and reporting of DSA, including information on MFI, their plausibility and possible cross-reactive antigens/epitopes	1B	4,5,8
Whilst post-transplant monitoring of preformed DSA in patients with stable graft function might be helpful, additional clinical and laboratory parameters should also be considered when deciding if a biopsy should be performed	2C	4,5,8
DSA MFI levels or complement binding ability (C1q, C4d, C3d) should not influence decision-making regarding whether a biopsy in patients with subclinical dnDSA should be performed	2C	4,5,8
We recommend optimization of maintenance therapy, including addressing non-adherence, in patients who develop subclinical dnDSA. Additional treatment should only be considered after performing an allograft biopsy	1C	6–7
Cost-effectiveness of DSA monitoring in patients with stable graft function depends on incidence rate of dnDSA and importantly on size effect of treatment	2D	9
Monitoring for dnDSA during functional graft life is a continuous process and should not change upon detection of dnDSA.	2C	10
The optimal DSA monitoring scheme has not been established, but a routine approach would be antibody monitoring at three to six months post-transplant and annually thereafter	2C	10