If the acute humoral rejection is of the peritubular capillary form, several abnormalities such as tubular necrosis, inflammation of the glomerular and peritubular capillaries can be observed via the light microscope. Cases of accompanying acute cellular rejection are also possible in acute humoral antibody-mediated rejection. Due to such coexistence of morphologic features that are similar for cellular and humoral rejection when depending on light microscopy, it is advisable to rely on C4d test when diagnosing acute humoral rejection (McKay & Steinberg, 2010).
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