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FIGURE 10-9 (see Color Plate)

FIGURE 10-9 (see Color Plate)

Antibody-mediated rejection with aggregates of polymorphonuclear leukocytes (polymorphs) in peritubular capillaries. This lesion is a feature of both classic hyperacute rejection and of later appearing antibody-mediated rejection, which is by far the more common entity. Antibody- and cell-mediated rejection can coexist, so one may find both tubulitis and intimal arteritis along with this lesion; however many cases of antibody-mediated rejection have a paucity of tubulitis [2]. The polymorph aggregates can be subtle, another reason for looking with care at the biopsy that appears to show "nothing."

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