New diagnostic methods of acute rejection after living donor liver transplantation

自1996年1月以来，东京大学医院共进行了63例活体肝移植。男性27例，女性36例（平均年龄：14.9岁，范围：8个月-62岁）。其中胆道闭锁40例，原发性胆汁性肝硬化8例，肝硬化7例，Alagille综合征2例，其他5例。免疫抑制剂以FK 506和类固醇为主。术后T-Bil、GOT、GPT、ALP、G-GTP升高诊断为急性排斥反应。52例患者中15例出现急性排斥反应，其余37例无排斥反应。组织学显示Gulissonian三联征中的细胞浸润、胆管和内皮细胞的破坏。此外，肝功能障碍伴外周血嗜酸性粒细胞增多高度提示急性排斥反应的存在。外周血细胞因子的变化与急性排斥反应无关。

At Tokyo University Hospital, 63 living-related liver transplantation have been performed since January, 1996. There were 27 males and 36 females (Average age : 14.9 years, range : 8 months-62 years). The diagnoses were biliary atresia in 40, primary biliary cirrhosis in 8, liver cirrhosis in 7, Alagille syndrome in 2 and others in the remaining 5. FK506 and steroid were employed as main immunosuppressive drugs. Acute rejection was diagnosed by the elevation of T-Bil, GOT, GPT, ALP and G-GTP, which was confirmed histologically. 15 of 52 patients showed acute rejection, whereas the remaining 37 had no rejection. Histology showed cellular infiltration in the Gulissonian triad, destruction of the bile duct and endothelialitis. Furthermore, liver dysfunction with eosinophilia in the peripheral blood highly suggested the presence of acute rejection. Whereas alteartions of cytokines in the peripheral blood were not specific to the acute rejection.