Recurrence of primary biliary cirrhosis and development of autoimmune hepatitis after liver transplant: A blind histologic study.
Recurrence of primary biliary cirrhosis and development of autoimmune hepatitis after liver transplant: A blind histologic study.
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肝移植后原发性胆汁性肝硬化的复发和自身免疫性肝炎的发展：一项盲法组织学研究。
DOI：
10.1111/j.1872-034x.2008.00483.x
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Thung,SwanN
中科院分区：
文献类型：
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作者：
Hytiroglou,Prodromos;Gutierrez,JulioA;Freni,Maria;Odin,JosephA;Stanca,CarmenM;Merati,Sukma;Schiano,ThomasD;Branch,AndreaD;Thung,SwanN
目的：这项长期研究旨在评估原位肝移植（奥尔特）后原发性胆汁性肝硬化（PBC）的复发和演变。方法：我们回顾了因PBC接受移植的女性患者（n= 84）和因慢性丙型肝炎病毒感染（CHCV）接受移植的女性患者（n= 108）的“盲法”同种异体移植物活检标本。 结果：4例PBC患者中，5例肝穿刺活检发现肉芽肿性破坏性胆管炎（P=0.0048），其中44例PBC患者83例，58例CHCV患者152例。 4名PBC患者的4份活检和1名CHCV患者的2份活检中存在非坏死性上皮样细胞肉芽肿。CHCV患者的片状坏死（P= 0.0002）、小叶坏死性炎症活动（P<0.0001）、脂肪变性（P<0.0001）和纤维化（P<0.0001）的发生率高于PBC患者。 4例PBC患者在奥尔特后平均3.66年发生了自身免疫性肝炎（AIH）的组织学证据。 其中1例患者具有AIH/PBC重叠综合征的组织学特征。所有4例患者均发生桥接纤维化（n= 2）或肝硬化（n= 2）。 没有其他PBC患者肝硬化的证据后奥尔特。结论：组织学检查结果表明，复发性PBC存在于15.9%的PBC患者进行活检，在这一系列。然而，与对照组相比，这组患者没有遭受显著的胆管损失或纤维化，这表明复发性PBC是一种轻度或缓慢进展的疾病。在一些PBC患者的移植物活检中观察到AIH的组织学证据。
Aim:This long‐term study aimed to evaluate recurrence and evolution of primary biliary cirrhosis (PBC) after orthotopic liver transplantation (OLT).Methods:We reviewed “blindly” allograft biopsy specimens of women who underwent transplantation for PBC (n= 84), and women who received a transplant for chronic hepatitis C virus infection (CHCV ) (n= 108). All needle liver biopsy specimens obtained more than 6 months post‐OLT were examined, including 83 specimens from 44 PBC patients and 152 specimens from 58 CHCV patients.Results:Granulomatous destructive cholangitis was found in five biopsies from four PBC patients (P= 0.0048). Non‐necrotizing epithelioid cell granulomas were present in four biopsies from four PBC patients, and in two biopsies from one CHCV patient. Piecemeal necrosis (P= 0.0002), lobular necroinflammatory activity (P< 0.0001), steatosis (P< 0.0001) and fibrosis (P< 0.0001) were more prevalent in CHCV patients than PBC patients. Four PBC patients developed histologic evidence of autoimmune hepatitis (AIH), at a mean time of 3.66 years post‐OLT. One of these patients had histologic features of AIH/PBC overlap syndrome. All four patients developed bridging fibrosis (n= 2) or cirrhosis (n= 2). No other PBC patient had evidence of cirrhosis after OLT.Conclusions:Histologic findings indicative of recurrent PBC were present in 15.9% of the PBC patients undergoing biopsy in this series. However, this group of patients did not suffer significant bile duct loss or fibrosis, as compared to the control group, suggesting that recurrent PBC is a mild or slowly progressive disease. Histologic evidence of AIH was observed in allograft biopsies of some PBC patients.