Antibody incompatible transplantation (AiT) is on the rise. This is because of advances in detection of donor specific antibodies, even at very low levels. In spite of this there is an increased risk of acute antibody mediated rejection. There are multiple protocols to prevent and treat antibody mediated rejection. Though they are reasonably successful in reversing acute rejection, graft loss still occurs due to ongoing chronic antibody mediated rejection.

Increasingly successful protocols enabling HLA antibody incompatible renal transplantation have resulted in a rise in the incidence of antibody mediated rejection. There are limited options to treat this feared complication. Eculizumab, a potent inhibitor of the complement cascade, has recently been suggested as a possible addition to treatment of AMR. We report the use of eculizumab in three very high risk transplant recipients.