What is your diagnosis in this renal transplant biopsy?
The photomicrograph shows a PAS-stained section of an artery. Severe, fibrous expansion of the intimal vascular layer is seen with numerous inflammatory cells embedded deep within the expanded intima as well as rare foam cells. These findings are consistent with transplant arteriopathy which represents chronic vascular damage, usually in the setting of antibody-mediated rejection. In this case, the patient had chronic, active antibody-mediated rejection (not shown) and a history of acute antibody-mediated rejection many months prior.
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