<h3>Purpose</h3> Antibody mediated rejection (AMR) has been linked to development of chronic lung allograft dysfunction (CLAD) either bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS). It has never been assessed if AMR characteristics could predict evolution towards a phenotype of CLAD and post-treatment outcomes. <h3>Methods</h3> Data from patients treated for AMR in our center with antibody depleting therapy (ADT) (plasma exchange, high dose corticosteroids, rituximab and intravenous immunoglobulin) were reviewed. We subsequently distinguished patients presenting with late acute graft failure (LAGF) or not. LAGF was defined as acute allograft failure associated with radiological or histopathological signs compatible with acute fibrinous and organizing pneumonia (AFOP), diffuse alveolar damage (DAD) or organizing pneumonia (OP). Evolution towards CLAD and survival was investigated using Fisher's exact test and Kaplan-Meier survival curve with log-rank test. Predictive factors of death after treatment were analyzed using multiple stepwise logistic regression. <h3>Results</h3> Forty eight patients were treated with ADT for AMR. At baseline, 67% presented with CLAD (38% BOS, 44% RAS, 18% mixed). 71% presented with a clinical picture of LAGF while 29% did not. After ADT, for patients who survived long enough for reevaluation (n=42), there was a majority of patients who evolved towards a CLAD phenotype BOS in the group without LAGF (BOS n=9, RAS n=4, no CLAD n=1) and towards CLAD phenotype RAS in the LAGF group (BOS n=6, RAS n=21, no CLAD n=1) (P = 0.0148). Kaplan-Meier survival curves displayed lower survival for patients with AMR and LAGF versus patients with AMR without LAGF (P=0.0335) (figure 1). Multivariate analysis showed that LAGF (P=0.0388) and acute respiratory failure (P=0.0040) were independent predictive factors for death. <h3>Conclusion</h3> AMR may present in two distinct phenotypes: one with LAGF which evolves towards RAS with poor prognosis and a second without LAGF which evolves towards BOS with better outcomes after ADT.