Arteriosclerosis, defined as new onset fibrous thickening of the vascular intima, is the morphologic hallmark of chronic rejection. Arteriosclerosis in an allograft biopsy can also be the result of aging, hypertension or donor disease. However, the presence of inflammatory cells in a fibrotic intima, disruptions of the elastica, and myofibroblast proliferation resulting in the formation of a second neointima, are changes considered to specific for chronic rejection.
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