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This image shows an arterial cross-section with features of chronic transplant arteriopathy (a.k.a. “sclerosing transplant vasculopathy” and “chronic allograft vasculopathy”). The lesion is characterized by fibrous intimal thickening of the arterial wall with lymphocytes (usually T-cells) and monocytes/macrophages within the thickened intima. Unlike some arteriosclerotic lesions in patients with hypertension, the arterial wall in chronic transplant arteriopathy lacks prominent accumulation of elastic fibers. Given the presence of mononuclear cells in the vessel wall, one must carefully search for endothelialitis. If found, a diagnosis of active vascular rejection, antibody-mediated rejection or acute T-cell-mediated rejection, should be considered.