The limited availability of organs for transplantation has driven the search for new strategies, such as the use of ABO and human leukocyte antigen (HLA) incompatible donor grafts for which antidonor antibodies (Abs) preexist in the recipient. The control of T-cell alloresponses has considerably improved over the last two decades thanks to the discovery of novel anti-T-cell molecules, dramatically reducing the incidence of acute cellular rejection. On the other hand, control of the humoral response remains a considerable challenge. Nevertheless, recent strategies, such as the use of plasma exchange, intravenous immune globulin, rituximab, bortezomib, or anti-C5 mAb (eculizumab), have helped to improve the success rate for so-called incompatible transplants. However, ABO and HLA incompatibility seems to be different. In fact, ABO-incompatible transplantation has improved considerably, with results now comparable with ABO-compatible transplants. On the contrary, HLA-incompatible transplantation with donor-specific Abs poses a higher risk of Ab-mediated rejection (ABMR), with a significant negative impact on graft survival. Graft survival despite the presence of antigraft Abs is known as “accommodation,” a phenomenon first described in the context of successful ABO-incompatible liver transplantation performed for acute liver failure (1). The first graft tissue with which antidonor Abs come into contact is the endothelium, whose response seems to be Ab-dependent. For example, endothelial cells (EC) seem to be particularly resistant to anti-A/B Abs in the context of accommodation, which is not the case for anti-HLA Abs, suggesting that differential EC pathways are involved in defining response to antidonor Abs. The study by Iwasaki et al. (2) aimed to compare the in vitro signal transduction pathways triggered in EC upon binding of anti-A/B and anti-HLA Abs, particularly in the context of accommodation. They showed that in resistance to complement-dependant cytotoxicity (CDC), the effect of EC preincubation with high-titer anti-A/B Abs was comparable with that of low-titer anti-HLA class I Abs. They additionally showed that a 1-hr incubation of EC with high-titer anti-A/B Abs up-regulated CD55 and CD59 by means of ERK1/2 pathway inactivation. However, a 1-hr incubation of EC with low-titer anti-HLA Abs resulted in reduced CDC, associated with an AKT pathway-dependent increase in mRNA expression of the cytoprotective proteins HO-1 and ferritin H. Given that CDC is the major (but not unique) mechanism by which Abs acutely aggress graft tissue, complement staining in graft biopsies, particularly C4d (or C3c/C3d), is considered as a good indicator of ABMR, especially in the context of donor-specific Abs. On the contrary, in ABO-incompatible transplantation, C4d or C3d staining is found in graft biopsies of stable nonrejected grafts without any correlation with poor outcome (3). The up-regulation of CD55 and CD59 shown by Iwasaki et al. (2) could explain the endothelial resistance to A/B Abs despite deposition of C4d and C3d, because the complement activation pathway is blocked at this step and cannot progress to full activation. In fact, the complement regulatory molecules CD55 and CD59 exert their inhibitory roles at multiple levels of the complement cascade: dissociation of C3 convertases by CD55 and prevention of membrane attack complex assembly by CD59. These roles are acted out locally at the site of Ab binding to EC, and a correlation exists between their up-regulated expression and the efficacy of CDC blockade. Their action is so efficient locally that in the field of xenotransplantation, this has spurred the generation of human CD55 or CD59 transgenic pigs expressing high levels of the human molecules on their EC, thereby preventing hyperacute ABMR in primate models. On another hand, the finding of reduced CDC through activation of the PI3K/AKT pathway and expression of cytoprotective genes upon EC preincubation with low-titer anti-HLA Abs well confirms the work of Reed et al. (4). The latter authors also reported on an induction of the antiapoptotic genes A20, Bcl-2, and Bcl-xL, driving EC to an accommodated profile. The identification of specific signaling pathways that could render EC resistant to Ab-mediated cytotoxicity would be of great value in transplantation, because it would help to understand how the status of accommodation may be acquired. Two parameters are obviously critical in this phenomenon referred here: Ab preincubation and Ab titer. So far, encouraging data such as these have only been observed in vitro and their confirmation in whole organs could justify strategies such as ex vivo preconditioning of donor organs with high-titer A/B Abs before A/B-incompatible transplantation or low-titer recipient anti-HLA Abs. Such strategies would aim to induce these particular protective pathways before transplantation in the context of prepared recipients (plasma exchange and immunosuppression) in an attempt to obtain accommodation in the context of HLA incompatibility.