What is the long-term outcome of the liver allograft?
What is the long-term outcome of the liver allograft?
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DOI：
10.1016/j.jhep.2011.03.005
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发表时间：
2011-09-01
影响因子：
25.7
通讯作者：
Huebscher, Stefan G.
中科院分区：
文献类型：
--
作者：
Huebscher, Stefan G.
随着肝移植（LT）后长期存活率的提高，与长期存活者的肝移植评估相关的问题变得越来越重要。组织学异常通常存在于移植后晚期活检中，包括来自表现良好且移植物功能良好的患者的方案活检。复发性疾病是移植物组织学异常的最常见原因，但可能会因免疫抑制或与其他移植物并发症的相互作用而改变，导致复杂或非典型变化。在移植后晚期活检中观察到的其他异常包括排斥反应（其通常与移植后时期观察到的表现不同），新发疾病，“特发性”移植后肝炎（IPTH）和结节性再生性增生。在许多情况下，移植物功能障碍有一个以上的原因，肝活检可能有助于确定移植物损伤的主要原因。用于描述移植物损伤模式的术语存在问题，但有新的证据表明，晚期排斥反应，新发自身免疫性肝炎和IPTH可能都是移植后晚期同种异体肝移植中发生的免疫介导损伤重叠谱的一部分。仔细的临床-病理相关性是非常重要的，活检报告的措辞应考虑到治疗意义，特别是是否可能表明免疫抑制的变化。本文将概述LT后长期存活者的主要组织学变化，重点关注移植后晚期活检评估与临床最相关的领域。(C)2011年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
With improved long-term survival following liver transplantation (LT), issues relating to the assessment of the liver allograft in long-term survivors are becoming increasingly relevant. Histological abnormalities are commonly present in late post-transplant biopsies, including protocol biopsies from patients who appear to be well with good graft function. Recurrent disease is the commonest recognised cause of abnormal graft histology, but may be modified by the effects of immunosuppression or interactions with other graft complications, resulting in complex or atypical changes. Other abnormalities seen in late post-transplant biopsies include rejection (which often has different appearances to those seen in the post-transplant period), de novo disease, "idiopathic" post-transplant hepatitis (IPTH) and nodular regenerative hyperplasia. In many cases graft dysfunction has more than one cause and liver biopsy may help to identify the predominant cause of graft damage. Problems exist with the terminology used to describe less well understood patterns of graft injury, but there is emerging evidence to suggest that late rejection, de novo autoimmune hepatitis and IPTH may all be part of an overlapping spectrum of immune-mediated injury occurring in the late post-transplant liver allograft. Careful clinico-pathological correlation is very important and the wording of the biopsy report should take into account therapeutic implications, particularly whether changes in immunosuppression may be indicated. This article will provide an overview of the main histological changes occurring in long-term survivors post-LT, focusing on areas where the assessment of late post-transplant biopsies is most relevant clinically. (C) 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.