Clinical and histologic patterns of early graft failure due to recurrent hepatitis C in four patients after liver transplantation
Clinical and histologic patterns of early graft failure due to recurrent hepatitis C in four patients after liver transplantation
复制标题
四例肝移植术后复发丙型肝炎导致早期移植失败的临床和组织学模式
DOI：
--
复制
发表时间：
1996
期刊：
影响因子：
--
通讯作者：
T. Pruett
中科院分区：
文献类型：
--
作者：
R. Dickson;S. Caldwell;M. Ishitani;J. Lau;C. Driscoll;W. Stevenson;C. Mccullough;T. Pruett
丙型肝炎病毒在原位肝移植后复发几乎是普遍现象。丙型肝炎引起的移植物衰竭可能会发生，但临床和组织学特征尚未明确。这项研究的目的是描述肝移植后复发的丙型肝炎患者早期移植物失败的模式。1989年10月至1994年9月，30例丙型肝炎患者接受了肝移植手术。4例患者因死亡(2例)、与丙型肝炎无关的移植物衰竭(1例)和失访(1例)而被排除。在剩下的26名患者中，有24名丙型肝炎复发。在4名丙型肝炎病毒复发和胆汁淤积的患者中，移植失败分别发生在5.25、11.0、11.0和18.5个月。对病历和肝活检进行复习。在所有4例患者中，以小叶中心气球状变性为特征的组织学模式发展和进展到累及三分之二以上的小叶。在植片处，所有移植物均有中到重度的胆汁淤积和桥接纤维化。两名患者在3个月的活组织检查中出现门脉炎症，与病毒性肝炎相符。所有患者都有轻微的大泡状脂肪变性，但只有1例患者有明显的淋巴集聚。没有患者有肝动脉血栓形成的证据。一名患者有潜在的药物引起的胆汁淤积。1例患者有3次排斥反应，不被认为是造成移植物丢失的原因。4例患者均出现肝功能衰竭的临床表现，并进行了再次移植。2例术后移植物衰竭早期复发。我们的结论是，在一些早期移植失败的丙型肝炎患者中，会出现进行性小叶中心气球状变性、桥接纤维化和胆汁淤积的模式，类似于一些复发乙肝的移植患者中出现的纤维化性淤胆性肝炎。
Hepatitis C viral recurrence after orthotopic liver transplantation is almost universal. Hepatitis C-induced graft failure may occur, but the clinical and histologic profiles are not well defined. The aim of this study was to describe the pattern of early graft failure in patients with recurrent hepatitis C after liver transplantation. Thirty patients with hepatitis C underwent liver transplantation from October 1989 through September 1994. Four patients were excluded because of death (2 patients), graft failure unrelated to hepatitis C (1 patient), and lost to follow-up (1 patient). Hepatitis C recurred in 24 of the 26 remaining patients. In 4 patients with hepatitis C virus recurrence and cholestasis, graft failure developed at 5.25, 11.0, 11.0, and 18.5 months. The medical records and liver biopsies were reviewed. In all 4 patients, a histologic pattern characterized by centrilobular ballooning degeneration developed and progressed to involve more than two-thirds of the lobules. Moderate to severe cholestasis and bridging fibrosis were present in all grafts at explant. Two patients had portal inflammation on 3-month biopsies consistent with viral hepatitis. All patients had mild macrovesicular steatosis, but only 1 patient had significant lymphoid aggregates. No patient had evidence of hepatic artery thrombosis. One patient had potential drug-induced cholestasis. One patient had 3 episodes of rejection that were not believed to contribute to graft loss. All 4 patients developed clinical features of hepatic failure and were retransplanted. Two patients had early recurrence of graft failure. We conclude that a pattern of progressive centrilobular ballooning degeneration, bridging fibrosis, and cholestasis occurs in some patients with hepatitis C with early graft failure, similar to fibrosing cholestatic hepatitis seen in some transplant patients with recurrent hepatitis B.
原位肝移植后复发性丙型肝炎的生化和组织学评估。
影响因子：
6.2
作者：
Shiffman,ML;Contos,MJ;Luketic,VA;Sanyal,AJ;Purdum3rd,PP;Mills,AS;Fisher,RA;Posner,MP
通讯作者：
Posner,MP