Pathology of human intestinal transplantation
Pathology of human intestinal transplantation
复制标题
DOI：
10.1053/gast.1996.v110.pm8964408
复制
发表时间：
1996-06-01
期刊：
影响因子：
29.4
通讯作者：
Demetris, AJ
中科院分区：
文献类型：
--
作者：
Lee, RG;Nakamura, K;Demetris, AJ
背景和目标：肠移植是治疗不可逆性肠功能衰竭或短肠综合征的一种新的治疗方法。本研究旨在描述人同种异体肠移植物的组织病理学，并确定肠排斥反应的特点。研究方法：回顾性分析62例受者3015例内镜活检标本和23例移植肠标本的组织学特征，并与临床表现进行对照。结果如下：急性排斥反应的特点是不同组合的隐窝损伤，粘膜浸润主要是单核细胞（包括母细胞淋巴细胞），并增加隐窝细胞凋亡（每10个隐窝中超过2个），它代表了一个斑片状的，通常以回肠为中心的过程，可能进展为粘膜溃疡;后期剧集（移植后100天以上）倾向于显示较早期发作更少的细胞浸润和更大的细胞凋亡，与临床排斥反应的相关性良好（假阳性率9%;假阴性率26%）。2例切除标本显示闭塞性动脉病变，提示慢性排斥反应，其他标本显示保存损伤、巨细胞病毒感染、移植后淋巴组织增生性疾病和非特异性的活动性或既往粘膜损伤。结论：粘膜活检标本是监测同种异体肠移植物的有效手段。基于临床相关性验证的特征，可以可靠地识别急性排斥，并且可以将其与影响肠同种异体移植物的其他病理过程区分开。
Background & Aims: Intestinal transplantation is a developing therapeutic option for patients with irreversible intestinal failure or short bowel syndrome, The aim of this study was to delineate the histopathology of human intestinal allografts and to define the features of intestinal rejection. Methods: The histological features of 3015 endoscopic biopsy specimens and 23 allograft specimens from 62 intestinal recipients were analyzed retrospectively and correlated with clinical findings. Results: Acute allograft rejection was characterized by a varying combination of crypt injury, mucosal infiltration primarily by mononuclear cells (including blastic lymphocytes), and increased crypt cell apoptosis (more than 2 per 10 crypts), It represented a patchy, often ileal-centered process that could progress to mucosal ulceration; later episodes (more than 100 days posttransplant) tended to show lesser cellular infiltration and greater apoptosis than earlier episodes, Correlation with clinical rejection was good (false-positive rate of 9%; false-negative rate of 26%). Two resected specimens showed obliterative arteriopathy indicative of chronic rejection, In other specimens, preservation injury, cytomegalovirus infection, post-transplant lymphoproliferative disorder, and nonspecific features of active or past mucosal injury could be recognized, Conclusions: Mucosal biopsy specimens are a useful means of monitoring intestinal allografts. based on features validated by clinical correlation, acute rejection can be identified reliably and can be differentiated from the other pathological processes affecting the intestinal allograft.