The plenary session on "End organ damage and repair" at the 21st International Vasculitis Workshop Congress featured two lectures and three studies addressing the pathogenesis, diagnosis, and management of fibrosis in vasculitis. The studies presented at the session demonstrate the importance of cellular interplay in driving inflammation and fibrosis, like the B cell-fibroblast interactions in the aorta of giant cell arteritis patients and the potential fibrotic role of specific infiltrating macrophage subtypes in ANCA-associated glomerulonephritis. Moreover, organ damage, such as the presence of interstitial lung disease in ANCA-associated vasculitis, may impact on long-term outcome, and need a personalized treatment approach.