The final diagnosis is worded as following: acute tubular necrosis-like changes with positive C4d stain in peritubular capillaries, suggestive of acute antibody-mediated rejection, type I (Banff Classification 2005). There is focal interstitial mononuclear cell infiltration. It is focal, without tubulitis. It is not enough for the diagnosis of concurrent "borderline changes suspicious for acute T-cell-mediated rejeciton".

A definitive diagnosis of acute antibody mediated rejection requires: 1) morphologic evidence of acute tissue injury, 2) immunopathologic evidence for antibody action, and 3) serologic evidence of circulatingdonor-specific antibodies.  If only two of three criteria are present, such a case should be considered "suspicious for or suggestive of" acute antibody-mediated rejection.

In this case, the glomerulus is unremarkable. In the photo #2 and #3, there are lymphoid cells or moncytes in peritubular capillaries. This type of change is often seen in actue antibody-mediated rejection.