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Chronic active T cell-mediated rejection (TCMR) was included in the 2017 Banff classification system for the evaluation of kidney allografts (see reference). This diagnosis recognizes the usually deleterious effects of interstitial inflammation on graft survival, even within areas of interstitial fibrosis and tubular atrophy (IFTA). The biopsy shows severe chronic inflammation (Fig. 1) in the setting of moderate to severe IFTA (Fig. 2), as well as foci of severe tubulitis in non-atrophic tubules (Fig. 3). Haas M, Loupy A, et al. Am J Transplant. 2018 Feb;18(2):293-307. PubMed PMID: 29243394