Organ transplantation is the ultimate treatment for various end-stage diseases, and cellular rejection has been effectively controlled due to the application of new immunosuppressants. However, humoral rejection, that is, the rejection mediated by donor-specific antibodies, is still an important factor leading to graft failure or even death of recipients. Antibody-mediated rejection plays a significant role in the development and progression of hyperacute rejection and chronic rejection, but the understanding is still limited in the medical community. This article reviews the mechanism, detection and treatment of antibody-mediated rejection.