A renal transplant recipient develops slowly progressive graft dysfunction over three years. Coronary angiography of the graft artery shows diffuse concentric narrowing. Biopsy of the vessel wall would show which lesion?

• A Concentric intimal hyperplasia with smooth muscle proliferation and lipid-laden macrophages ✓
• B Fibrinoid necrosis of the media with transmural inflammation
• C Amyloid deposition in the adventitia
• D Thrombotic microangiopathy with glomerular capillary thrombi

Explanation

Chronic rejection manifests as graft vascular disease, also called transplant arteriopathy: progressive concentric intimal thickening caused by proliferation of donor smooth muscle cells recruited by cytokines from chronic immune injury, eventually causing ischaemic atrophy and fibrosis of the parenchyma. Fibrinoid necrosis describes acute vascular rejection, and thrombotic microangiopathy suggests recurrent disease or CNI toxicity. This diffuse concentric pattern differs from eccentric atherosclerotic plaques.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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