OBJECTIVE: To observe the diagnosis and treatment methods of acute antibody-mediated rejection within 3 months after transplantation of renal insufficiency. Methods: 106 patients were diagnosed with acute antibody-mediated rejection after renal transplantation, and histopathological examination of transplanted kidney puncture biopsy was performed under ultrasound guidance to observe the pathological changes of transplanted kidney; immunohistochemical staining was used to observe the expression of C4d in transplanted kidney; plasma replacement and intravenous low-dose gammaglobulin were given after acute antibody-mediated rejection was diagnosed, and the treatment effect was observed. Results: 2 cases of hyper-acute rejection and 15 cases of acute antibody-mediated rejection in transplanted kidney; immunohistochemical staining showed positive C4d expression; 2 cases of hyper-acute rejection had transplanted kidney failure and transplanted kidney was removed; 13 cases of 15 patients with acute antibody-mediated rejection recovered transplanted kidney function after treatment, 2 cases did not recover transplanted kidney function, and blood creatinine was stable at a high level. Conclusion: Histopathology of transplantation kidney puncture biopsy is important for the diagnosis of transplantation renal insufficiency after renal transplantation, and plasma replacement and intravenous low-dose gammaglobulin have positive effects in the treatment of acute antibody-mediated rejection after transplantation renal insufficiency.