A renal allograft recipient has slowly rising creatinine over three years despite adherence to immunosuppression. Graft biopsy shows concentric intimal thickening of arteries with luminal narrowing, interstitial fibrosis, and tubular atrophy, without significant lymphocytic tubulitis. This histological picture represents:
- A Chronic rejection with transplant arteriopathy ✓
- B Acute cellular rejection
- C Thrombotic microangiopathy from calcineurin inhibitor toxicity
- D Recurrent IgA nephropathy
Correct answer: A. Chronic rejection with transplant arteriopathy
Explanation
Chronic rejection is defined morphologically by transplant arteriopathy: proliferative intimal thickening of arteries caused by smooth muscle cell migration and proliferation driven by chronic alloimmune and inflammatory injury, accompanied by interstitial fibrosis and tubular atrophy. Acute cellular rejection shows interstitial lymphocytic infiltrates with tubulitis, which is explicitly absent here. Calcineurin inhibitor toxicity produces striped interstitial fibrosis and arteriolar hyalinosis rather than obliterative endarteritis.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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