肝移植排斥反应中C4d的表达意义

Signification of C4d deposition in liver rejection

目的:研究肝移植排斥反应中C4d沉积的部位和意义方法:对肝移植患者的肝穿刺标本作C4d免疫组化染色,观察C4d阳性沉积情况与肝脏病理改变的关系.结果:急性细胞性排斥反应中的69.2%肝移植标本,在肝小叶汇管区小血管壁及肝血窦壁上有C4d的沉积.33.3%移植后乙肝复发和28.6%乙型肝炎的标本中,仅汇管区小血管壁有C4d的沉积,而无肝血窦壁上C4d的沉积.12例器官保存性损伤的肝标本中1例汇管区小血管壁及肝血窦壁上有C4d的沉积,此例1mo后再次穿刺发现急性细胞性排异反应.肝移植后胆管阻塞的标本中没有发现C4d的沉积.结论:C4d在肝血窦壁的沉积可以作为肝移植急性排斥反应鉴别诊断一个比较特异的免疫组化指标.

AIM: To investigate the location and significance of C4d deposition in liver rejection. METHODS: Immunohistological staining was performed to observe C4d deposition in the liver allografts biopsies as well as its relationship with the pathological alteration of liver. RESULTS: C4d expression was 69.2% in the samples of liver cellular rejection, 33.3% in hepatitis B relapse after transplantation and 28.6% in hepatitis B. In the biopsies of liver rejection, C4d was found depositing on the vascular walls of portal areas and hepatic sinusoidal walls. In the biopsies of hepatitis B relapse after transplantation and hepatitis B, C4d deposited only in the vascular walls of portal area. In the biopsies of ischemia reperfusion damage, C4d deposition was observed on the vascular walls of portal areas and hepatic sinusoidal wall in 1 of 12 patients, and follow-up biopsy after 1 month revealed an acute cellular rejection. No C4d deposition was observed in bile duct occlusion after liver transplantation. CONCLUSION: C4d deposition may be served as a sensitive marker in the diagnosis of liver rejection.