This scenario describes chronic rejection in a heart transplant, often manifesting as 'cardiac allograft vasculopathy' (CAV). Chronic rejection is a slow, progressive process occurring months to years after transplantation, characterized by fibrosis and vascular changes. In the heart, this involves concentric intimal thickening of coronary arteries due to proliferation of smooth muscle cells and extracellular matrix deposition, leading to luminal narrowing and ischemia. Lymphocytic myocarditis is characteristic of acute cellular rejection. Widespread thrombosis is seen in hyperacute rejection. Granulomatous inflammation is not typical for chronic rejection.
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