South AM et al. – The study evaluated the effects of antibody–mediated rejection (ABMR) and persistent C4d+ on follow–up biopsy on graft failure. A retrospective cohort study of 17 pediatric renal transplant patients with ABMR showed 41% of the patients achieved ≥50% reduction in expected glomerular filtration rate, transplant glomerulopathy, or graft failure at 12 months. While the 41% of patients showed significant association of C4d+ on follow–up biopsy with higher urine protein to Creatinine ratio, the association was not significant for graft failure. Thus, patients who are C4d+ on follow–up biopsy may require longer and aggressive treatment for ABMR.