494例次移植肝穿刺活检病理组织学分析

Histopathology after orthotopic liver transplantation: an analysis of 494 liver biopsies

目的 通过对 35 4例 (4 94例次 )移植肝穿刺活检组织进行病理分析 ,观察移植肝的组织学变化 ,探讨其出现肝功能不全的原因。方法 移植肝穿刺活检组织经 10 %中性福尔马林固定 ,快速石蜡连续切片 ,常规HE染色。部分病例做VG、Masson、PAS、网状纤维组织化学和免疫组织化学染色 ,抗体为HBsAg、HBcAg、HCVAg、CMV、CD8、CD4、CK19。对排斥反应病例 ,依照国际统一的BANFF标准进行急性排斥反应分级 ,应用排斥活动指数 (RAI)进行排斥反应程度评分。结果 急性细胞性排斥反应最常见 ,180例 (5 0 85 % ) ,慢性排斥反应 11例 (3 11% ) ,再灌注缺血损伤 2 0例 (5 6 5 % ) ,胆汁淤滞及急慢性小胆管炎 6 4例 (18 0 8% ) ,药物性肝损害 18例 (5 0 8% ) ,移植肝无功 1例 (0 2 8% ) ,CMV感染 2 4例 (6 78% ) ,乙肝病毒再感染及乙肝复发 2 7例 (7 6 3% ) ,丙型肝炎复发 2例 (0 5 6 % ) ,原发性硬化性胆管炎复发 1例 (0 2 8% ) ,难以诊断 6例 (1 6 9% )。

Purpose To observe histopathologic characteristics of post-transplantation liver and to investigate the causes of liver dysfunction after orthotopic liver transplantation (OLT). Methods All 494 cases of post-transplantation liver biopsies were analyzed by using routine HE staining, partly combined with VG, Masson, PAS, Gomori staining and immunohistochemical detection, including HBsAg, HBcAg, HCVAg, CMV, CD4, CD8 and CK19. Hepatic allograft rejection was determined according to Banff standard. Results Acute rejection was observed in 180 cases (50.85%), and chronic rejection, ischemia/reperfusion injury, cholangitis, drug-induced hepatitis, allograft dysfunction, CMV infection, relapses of HBV, HCV and primary sclerosing cholangitis were also found in 11 (3.11%), 20 (5.65%), 64 (18.08%), 18 (5.08%), 1 (0.28%), 24 (6.78%), 27 (7.63%), 2 (0.56%), and 1 (0.28%) cases, respectively. 6 cases of liver biopsies were unable to be diagnosed exactly by the above methods. Conclusions Liver biopsy is one of important methods to diagnose various complications of liver transplantation and it has a significant value in selection of suitable treatments.