肝脏移植后排斥反应的病理诊断

PATHOLOGICAL DIAGNOSIS OF LIVER GRAFT REJECTION

目的 探讨肝移植排斥反应的病理诊断。方法 综述近 10余年来对肝移植排斥反应诊断的文献资料。结果 体液性排斥反应较少见 ,主要表现为移植后数天或 1周内移植肝血管内血栓形成、肝损伤或坏死 ,较肾、心移植发生晚。急性排斥反应一般按Banff标准诊断。慢性排斥反应主要是汇管区小叶间胆管消失 ,肝动、静脉炎变 ,纤维化 ,管腔变窄 ,肝细胞炎变、斑点状坏死 ,但发生率较肾、心、肺、胰等移植为低。结论 Banff标准可作为目前诊断肝移植排斥反应的最重要依据。

Objective To evaluate the pathologi cal diagnosis of liver allograft rejection. Methods Literatures about diagnosis of live r transplantation rejection in recent ten years were reviewed.Results Humoral rejection was rare. The main fe atures were graft blood vessel thrombosis and liver damage and necrosis about so me days or one week after transplantation. The humoral rejection of liver graft occurred later than that of kidney and heart transplantation. The diagnosis of a cute liver graft rejection was based on Banff Schema. During chronic rejection i ntrahepatic bile ducts among hepatic lobules in portal area disappeared, and inf lammation, fibrosis and stricture of hepatic arteries and veins were found, but the morbidity was less than that of kidney, heart, lung and pancreas grafting. Conclusion Banff standard is the most important base of diagnosing liver graft rejection.