IMPRESSION:<\/strong> Features suggestive of active ABMR, with recommendation for correlation with circulating DSAs.<\/p>\n According to the Banff 2019 criteria, ABMR diagnosis requires:<\/p>\n This patient demonstrated peritubular capillaritis and focal C4d positivity, with known DSAs, fulfilling criteria for ABMR. The presence of moderate IFTA indicates chronic injury, which may limit reversibility.<\/p>\n Figure 1 – Histopathological slide of Mr V, with ABMR changes- peritubular capillaritis and chronic changes<\/p>\n PATHOPHYSIOLOGY<\/strong><\/p>\n ABMR results from DSAs binding to donor HLA antigens, activating complement, and causing endothelial injury. Chronic ABMR leads to transplant glomerulopathy and progressive graft loss.<\/p>\n This case highlights the diagnostic complexity of post-transplant dysfunction, where overlapping etiologies such as calcineurin inhibitor toxicity and ABMR coexist. Vigilant monitoring, timely biopsy, and correlation with DSA levels are essential for guiding therapy and improving graft survival.<\/p>\n Colvin RB, Smith RN. Antibody-mediated organ-allograft rejection. Nat Rev Immunol<\/em>. 2005;5(10):807\u2013817.<\/p>\nDISCUSSION<\/h2>\n
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