Histological recurrence of autoimmune liver diseases after living-donor liver transplantation
Histological recurrence of autoimmune liver diseases after living-donor liver transplantation
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DOI：
10.1111/j.1872-034x.2007.00245.x
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发表时间：
2007-10-01
影响因子：
4.2
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
--
作者：
Haga, Hironori;Miyagawa-Hayashino, Aya;Uemoto, Shinji
背景：活体肝移植（LDLT）对自身免疫性肝病复发的影响尚未得到充分记录。遗传相似性可能有利于避免严重排斥反应，但可能会促进自身免疫性疾病的复发。由于自身免疫性肝病有家族性记录，因此亲属供体候选者可能与受者患有相同的疾病。 方法：1994年11月至2004年6月期间，50例原发性胆汁性肝硬化（PBC）患者（16例非血缘关系供者和34例血缘关系供者）和28例原发性硬化性胆管炎患者(PSC) 在京都大学医院接受了 LDLT。结果：在 35 名存活超过 1 年的 PBC 患者中，10 名患者 (29%) 出现复发性 PBC，10 名复发性 PBC 患者中的 9 名 (90%) 与血液亲属供者有关（平均随访时间为 30 个月；范围为 2-68）。两名受者的供体具有 PBC 的某些临床或组织学特征，他们的移植物出现了复发性 PBC。在任何复发性 PBC 患者中均未观察到肝硬化或移植物衰竭。对于 LDLT 后存活超过 1 年的 PSC 患者，22 例中有 13 例 (59%) 显示出与 PSC 相容的组织学和放射学结果（平均随访时间为 31 个月；范围为 22-71 个月），其中 5 例死亡或接受了再移植。人类白细胞抗原-DR15与溃疡性结肠炎PSC的易感性呈正相关。一名捐献者被发现患有腹膜后纤维化，但没有硬化性胆管炎的证据。结论：血缘捐献者可能与复发性自身免疫性疾病的易感性有关。 PSC 的复发（而非 PBC）对 LDLT 的结果产生不利影响。应小心，因为血液亲属捐献者可能面临自身免疫性肝病的风险。
Background: The effects of living donor liver transplantation (LDLT) on the recurrence of autoimmune liver diseases have not been well documented. Genetic similarities may be beneficial to avoid severe rejection but may facilitate the recurrence of autoimmune diseases. Because familial occurrence of autoimmune liver diseases has been documented, there is a possibility that candidates for living-related donors may have the same disease as that of the recipients.Method: Between November 1994 and June 2004, 50 patients with primary biliary cirrhosis (PBC) (16-non-blood-relative donors and 34 blood-relative donors), and 28 patients with primary sclerosing cholangitis (PSC) underwent LDLT in Kyoto University Hospital.Results: Among 35 patients with PBC who survived more than 1 year, 10 patients (29%) showed recurrent PBC, and nine of 10 patients with recurrent PBC (90%) were associated with blood-relative donors (mean follow-up period, 30 months; range, 2-68). Two recipients had donors with some clinical or histological characteristics of PBC, and their grafts developedrecurrent PBC. Cirrhosis or graft failure was not observed in any patients with recurrent PBC. For PSC patients who survived more than 1 year after LDLT, 13 of 22 (59%) showed PSC-compatible histology and radiological findings (mean follow-up period, 31 months; range, 22-71), and five died or underwent retransplantation. Human leukocyte antigen-DR15 was positively associated with susceptibility to PSC with ulcerative colitis. One donor was revealed to have retroperitoneal fibrosis without evidence of sclerosing cholangitis.Conclusions: Blood-relative donors may be associated with susceptibility to recurrent autoimmune diseases. Recurrence of PSC, but not PBC, adversely affected the outcome of LDLT. Caution should be taken as blood-relative donors can be at risk of autoimmune liver diseases.