肝移植后肝脏组织活检的动态病理学分析

Analysis on Pathological Data of Liver Biopsies after Orthotopic Liver Transplantation

目的:分析肝脏组织活检在肝移植后常见并发症鉴别诊断中的作用。方法:在52例原位肝移植中,27例因肝功能障碍在术后0～330d不等接受肝脏活检。其中经皮肝穿刺44次,肝脏楔形活检6次,总计活检50次。标本经常规行HE染色,并根据需要加染组织化学或免疫组织化学染色后作显微镜观察。结果:急性排斥反应分别占受检病例及总移植病例数的48.15%和25.00%;慢性排斥反应分别占两者之14.81%和7.69%;保存/再灌注损伤分别占25.93%和13.46%;肝动脉栓塞分别占11.11%和5.77%;肝内胆道损伤占7.41%和3.85%;CMV感染占3.70%和1.92%;肝炎复发占3.70%和1.92%;可疑药物性肝损伤占11.11%和5.77%。结论:急性排斥反应和保存/再灌注损伤是移植后早期肝功能障碍的主要因素;肝动脉栓塞和供肝冷缺血可导致肝内胆道损伤;急性排斥反应及病毒感染与慢性排斥反应的发生有关;而药物诱发的肝损伤因缺乏特异性改变则应密切结合临床并采取排除诊断法。

Objective: To analyze the role of liver biopsies in differentiating pathological states after liver transplantation. Methods: A total of 50 biopsies were taken from 27 patients with liver dysfunction following 52 cases of liver transplantation. Biopsy specimens were obtained in 0～330 days of post-transplantation, 44 of them were taken by fine needle biopsy, 6 by wedge biopsy during surgery. All tissues were dyed by haemotoxylin-eosin stain; histochemical or immunohistochemical staining was applied whenever needed. Results: Acute rejection was found in 48.15% of the cases undergoing biopsy and in 25% of all the tranplant cases; the ratio of chronic rejection occupied 14.81% and 7.69%; preservation/reperfusion injury in 25.93% and 13.46% of the cases; hepatic artery thrombosis in 11.11% and 5.77% of the cases; intrahepatic biliary injury ratio in 7.41 % and 3.85%; CMV infection in 3.70 % and 1.92%; hepatitis B recurrence in 3.70 % and 1.92%; suspected drug-induced injury in 11.11% and 5.77%. Conclusions: Acute rejection and preservation/reperfusion injury are the major factors causing early liver dysfunction after liver transplantation. Hepatic artery thrombosis and ischemia are apt to induce intrahepatic biliary injury. Acute rejection and viral infection may lead to chronic rejection. Since there do not exist specific lesions in drug-induced injury, the diagnosis should be made by closely studying clinical history and by excluding other possible complications.