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Background: The hostile immune environment created by allotransplantation can accelerate pathologic tissue remodeling. Both overt and indolent inflammatory insults propel this remodeling, but there is a paucity of tools for monitoring the speed and severity of remodeling over time. Methods: This retrospective cohort consisted of n = 2,167 digitized heart transplant biopsy slides along with records of prior inflammatory events and future allograft outcomes (cardiac death or allograft vasculopathy). Utilizing computational pathology analysis, biopsy images were analyzed to identify the pathologic stromal changes associated with future allograft loss or vasculopathy. Biopsy images were then analyzed to assess which historical inflammatory events drive progression of these pathologic stromal changes. Results: The top 5 features of pathologic stromal remodeling most associated with adverse allograft outcomes were also strongly associated with histories of both overt and indolent inflammatory events. Compared to controls, a history of high-grade or treated rejection was significantly associated with progressive pathologic remodeling and future adverse outcomes (32.9% vs 5.1%, p