Orthotopic Liver Transplantation: A Pathological Study of 63 Serial Liver Biopsies from 17 Patients with Special Reference to the Diagnostic Features and Natural History of Rejection
Orthotopic Liver Transplantation: A Pathological Study of 63 Serial Liver Biopsies from 17 Patients with Special Reference to the Diagnostic Features and Natural History of Rejection
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原位肝移植：对 17 名患者的 63 份连续肝活检进行病理学研究，特别参考诊断特征和自然排斥史
DOI：
10.1002/hep.1840040620
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发表时间：
1984
期刊：
影响因子：
13.5
通讯作者：
N. Ascher
中科院分区：
文献类型：
--
作者：
D. Snover;R. Sibley;D. Freese;H. Sharp;J. Bloomer;J. Najarian;N. Ascher
对17例患者的63份连续活检标本进行了原位肝移植的组织病理学分析。在肝脏插入时（6次活检）、肝功能异常发生时（11次活检）和既往异常活检随访时（46次活检）进行活检。在插入时进行的活检均显示弥漫性肝细胞气球样变，其中1例合并坏死区域。在排斥反应发生时进行的活检（9例）均显示混合性门静脉炎性浸润、胆管损伤和中央或门静脉内皮细胞增生（即，淋巴细胞附着于静脉内皮）。随访活检显示了几种模式，包括：（i）急性排斥反应的变化消退，随后发生复发性急性或慢性排斥反应（4例）;（ii）模拟肝外胆道梗阻的长期急性排斥反应（4例）;（iii）长期急性排斥反应，嗜酸性粒细胞占主导地位，模拟药物反应（iv）快速进行性急性排斥反应导致死亡（1例）。在移植时对移植肝进行活检，可以为以后的活检提供一个比较的基线。在肝功能发生变化时进行活组织检查对于在免疫抑制改变之前确认排斥反应的存在至关重要。
The histopathological features of orthotopic liver transplants were evaluated in 63 serial biopsy specimens from 17 patients. Biopsies were taken at the time of insertion of the liver (six biopsies), at the time of development of liver function abnormalities (11 biopsies) and as follow‐up to previously abnormal biopsies (46 biopsies). The biopsies taken at the time of insertion all showed diffuse hepatocellular ballooning with confluent areas of necrosis in one case. Biopsies taken at the time of onset of rejection (nine cases) all showed a mixed portal inflammatory infiltrate, bile duct damage and central or portal vein endothelialitis (i.e., attachment of lymphocytes to the vein endothelium). Follow‐up biopsies showed several patterns including: (i) resolution of changes of acute rejection with subsequent development of recurrent acute or chronic rejection (four cases); (ii) prolonged acute rejection simulating extrahepatic biliary obstruction (four cases); (iii) prolonged acute rejection with predominance of eosinophils simulating a drug reaction (one case); and (iv) rapidly progressive acute rejection leading to death (one case). Biopsy of the transplanted liver at the time of transplantation is useful to provide a baseline for comparison with later biopsies. Biopsy at the time of onset of changes in liver function is essential to confirm the presence of rejection prior to alteration of immunosuppression.