In an allograft biopsy, what would be your diagnosis for this combination of findings?
The biopsy shows evidence of microvascular inflammation, both in the form of glomerulitis and pertitubular capillaritis. There is also capillary wall double contouring, consistent with transplant glomerulopathy. This combination of findings is most consistent with chronic active antibody-mediated rejection. To confirm this diagnosis, there would also need to be evidence of current or recent antibody interaction with the vascular endothelium through positive C4d staining and serologic evidence of donor-specific antibodies (DSAs) to HLA or other antigens (anti-AECA, anti-MICA/MICB, or anti-AT1R antibodies).
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