Transplant Question 22

A 56-year-old woman is eight years post-heart transplant for familial dilated cardiomyopathy.  She has not had any episodes of rejection since the first year post-transplant, and has enjoyed an excellent level of function.  Immunosuppression includes tacrolimus and mycophenolate mofetil.  She now describes some mild shortness of breath on exertion, and her echocardiogram demonstrates abnormal left ventricular filling indicating moderate diastolic dysfunction.  Coronary angiography reveals no flow limiting stenoses.  Her right heart catheterization reveals a right atrial pressure of 10 mmHg that increases to 16mmHg with inspiration (Kussmaul’s sign). 

What do you expect to see on biopsy?

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