慢性乙型肝炎磁共振扩散成像与病情程度的关系

目的探讨慢性乙型肝炎磁共振弥散成像与肝炎严重程度之间的相关性，评价磁共振弥散成像在慢乙肝中的应用价值。方法30例行肝穿刺活检的慢性乙型肝炎患者和10例健康志愿者在1．5T磁共振设备上行弥散成像，测表观弥散系数（ADc）值，弥散敏感系数b值取50、100、300及500、700s／mm^2。30例患者病理结果按Knodell HAI积分系统分级，比较各级的ADC值。结果不同分度的慢性乙型肝炎ADC值之间有一定的差异。b值选700s／mm^2时，肝脏纤维化患者和无纤维化者ADC值差异有统计学意义，炎症积分和纤维化积分低级别和高级别间ADC值差异也有统计学意义。结论磁共振弥散成像是一种有价值的慢性乙型肝炎分级的诊断方法。     

磁共振弥散加权成像对慢性乙型肝炎肝纤维化程度和炎症活动程度的判断价值分析

目的探讨磁共振弥散加权成像(MR-DWI)对慢性乙型肝炎肝纤维化程度和炎症活动程度的判断价值。方法选择我院自2014年1月至2016年1月我院收治的84例慢性乙型肝炎肝纤维化患者和30例未发生肝纤维化患者(对照组)为研究对象,选取同期在我院门诊体检的30例健康人为正常组。所有研究对象均经肝穿刺及病理学检查证实并接受腹部MRI平扫及DWI检查,比较各组间不同弥散敏感系数(b)值时的表观弥散系数(ADC)值的差异,分析ADC值和肝纤维化程度(分为S1、S2、S3和S4组)和肝炎活动程度(分为G1、G2、G3和G4组)之间的相关性。结果当b值为100s/mm~2、200s/mm~2和400s/mm~2时,不同肝纤维化程度组间ADC值差异均无统计学意义(均P0.05);而当b值为600s/mm~2和800s/mm~2时,S3组和S4组ADC值明显低于其他各组,差异均有统计学意义(均P0.05)。当b值为100s/mm~2和2000s/mm~2时,不同肝炎活动程度组间ADC值差异均无统计学意义(均P0.05);而当b值为400s/mm~2、600s/mm~2和800s/mm~2时,G3组和G4组ADC值明显低于其他各组,差异均有统计学意义(均P0.05)。相关性分析结果表明,当b值为600s/mm~2和800s/mm~2时,ADC值与肝纤维化程度呈现出明显的负相关(r值分别为-0.563和-0.624,均P0.05);当b值为400s/mm~2、600s/mm~2和800s/mm~2时,ADC值与肝炎活动程度呈现出明显的负相关(r值分别为-0.486、-0.586和-0.675,均P0.05)。结论磁共振弥散加权成像对于诊断慢性乙型肝炎患者肝纤维化程度具有极高的临床价值,当b值为800s/mm~2时临床价值最高,且ADC值与肝纤维化程度和炎症活动程度密切相关,是一种值得推广应用的诊疗方法。     

3.0 T MR弥散加权成像对鉴别胰腺癌与慢性肿块型胰腺炎的价值

目的探讨在3．0T磁共振（MR）平台上应用弥散加权成像（diffusion—weighted imaging，DWI）鉴别诊断胰腺癌与慢性肿块型胰腺炎的价值。方法纳入经手术病理和临床随访证实的胰腺癌患者13例、慢性肿块型胰腺炎患者7例和健康志愿者14例，在行上腹部常规MR扫描后进行胰腺DWI检查。采用自旋回波回波平面成像技术和空间敏感性编码技术，分别取弥散梯度b值=400、600、800和1000s／mm^2获得相应的DWI图像，测量感兴趣区（ROI）的ADC值，并进行统计学分析。结果①健康志愿者胰腺DWI呈中等信号。②胰腺癌患者癌组织在DWI上呈均匀高信号，边界较清楚；各b值（400、600、800和1000s／mm^2）下，测得ADC值分别为（1．63±0．235）、（1．42±0．126）、（1．36±0．170）及（1．26±0．178）×10^-3mm^2／s，明显低于癌周胰腺组织[（2．11±0．444）、（1．83±0．230）、（1．81±0．426）及（1．60±0．230）×10^-3mm^2／s]及健康志愿者胰腺的ADC值[（1．85±0．350）、（1．69±0．290）、（1．67±0．268）及（1．42±0．221）×10^-3mm^2／s]，P〈0．05。③慢性肿块型胰腺炎在DWI上呈不均匀稍高信号，边界不清；各b值下测得ADC值分别为（1．69±0．150）、（1．56±0．119）、（1．59±0．172）及（1．35±0．080）×10^-3mm^2／s，均高于胰腺癌组织的ADC值，但仅当b值-800s／mm^2时，与胰腺癌组织间差异有统计学意义（P〈0．05）。结论DWI可以清楚显示胰腺肿瘤病灶及范围，结合ADC的测量值能够为鉴别胰腺癌与慢性肿块型胰腺炎提供一定的信息。     

高弥散敏感因子(b)值DWI 及ADC 值对前列腺癌与前列腺炎鉴别诊断的应用对比分析

目的:探讨高弥散敏感因子(b)值扩散加权成像(DWI)及表面扩散系数(ADC)在前列腺癌和前列腺炎鉴别诊断的应用价值。方法:回顾性分析2018年4月—2019年9月经手术、活检病理或随访证实最终诊断的前列腺癌21例(25个病灶)和前列腺炎20例(28个病灶)。所有患者于手术或穿刺前行MRI扩散加权成像,b值选择1000、2000、3000 s/mm^2,观察不同b值的DWI及ADC值对前列腺癌和前列腺炎的定性诊断准确率。比较不同b值的DWI及ADC值在前列腺癌和前列腺炎病变诊断中有无统计学意义,分别计算出不同的b值DWI诊断前列腺癌和前列腺炎的诊断效能。结果:b值选择为1000、2000、3000 s/mm^2 DWI在前列腺癌和前列腺炎病变鉴别诊断中均有统计学意义(P<0.05),b值选择1000、2000、3000 s/mm^2在DWI诊断前列腺癌和前列腺炎的特异性、准确度分别为71.4%、84.9%,92.9%、92.5%,100.0%、96.2%,b值选择2000、3000 s/mm^2 DWI诊断前列腺癌和前列腺炎的特异性、准确度高于b值选择1000 s/mm^2 DWI。b值选择为1000、2000、3000 s/mm^2时,前列腺癌的ADC值均低于前列腺炎,并且b值选择为1000、2000、3000 s/mm^2所测得的ADC值前列腺癌和前列腺炎组间差异有统计学意义(P<0.05)。结论:采用高b值DWI及ADC值可以准确区分前列腺癌和前列腺炎,具有良好的定性诊断价值。     

MRI增强扫描及DWI扫描在肝脏良恶性肿瘤鉴别诊断中的应用

目的探讨腹部磁共振成像(MRI)增强扫描及弥散加权成像(DWI)技术在行手术治疗肝脏肿瘤患者良恶性鉴别诊断中的应用。方法研究纳入2018年1月至2021年6月行手术治疗肝脏结节患者共160例，均行腹部MRI增强扫描及DWI扫描检查，根据肿瘤类型分组，分析各类病灶DWI序列下表观弥散系数(ADC)值，比较腹部MRI增强扫描及DWI扫描单用或联用诊断肝脏良恶性肿瘤符合率。结果在弥散敏感系数(b)值分别设置为50 s/mm³、400 s/mm³及800 s/mm³条件下，肝细胞癌及肝转移癌病灶ADC值均显著低于肝血管瘤、肝囊肿(P<0.05);b值设置为800 s/mm³条件下肝脏良恶性病灶ADC值均显著低于50 s/mm³、400 s/mm³(P<0.05)；同时b值设置为400 s/mm³条件下肝脏良恶性病灶ADC值均显著低于50 s/mm³(P<0.05)；腹部MRI增强扫描联合DWI扫描用于肝...     

3．0T磁共振背景抑制弥散加权成像对直肠癌淋巴结转移的诊断价值

目的评估3．0T磁共振背景抑制弥散加权成像（DWIBS）对直肠癌转移性淋巴结的诊断价值。方法35例直肠癌患者术前行常规MRI加弥散加权成像（DWI）检查．手术行直肠癌切除加淋巴结清扫术。对照术后病理结果,确定转移性和非转移性淋巴结,测量淋巴结的表观弥散系数（ADC）值以及长、短径,并绘制受试者工作特征（ROC）曲线来评估淋巴结ADC值及长、短径对转移性淋巴结的鉴别诊断价值。结果35例直肠癌患者共获取部位明确的淋巴结151枚．其中转移性淋巴结65枚,非转移性淋巴结86枚。其ADC值分别为[（0．86±0．14）×10^-3]和[（0．94±0．16）×10^-3]mm^2／s,长径分别为（9．78±3．13）和（7．90±1．77）mm,短径分别为（7．65±2．00）和（6．45±1．19）mm,两者比较差异均有统计学意义（均P〈0．01）。ADC值、淋巴结长径、短径判断淋巴结是否转移的ROC曲线下面积分别为0．648、0．706、0．692,取最佳分界值[分别为（1．05×10^-3]mm^2／s、7．95mm、5．90mm]．三者的敏感性和特异性分别为93．8％和30．2％、75．4％和61．6％、90．8％和38．4％。结论3．0T磁共振DWIBS的ADC值的定量测量能够反映病灶的弥散受限程度．直肠癌转移性淋巴结的诊断需要ADC值、淋巴结径线测量的综合评价。     

3.0T磁共振扩散加权成像诊断肾血管 平滑肌脂肪瘤

目的探讨MR扩散加权成像（DWI）及相应的表观扩散系数（ADC）对肾血管平滑肌脂肪瘤（AML）的诊断价值。方法收集经手术病理证实的肾脏AML患者15例,其中典型AML 10例,不典型AML 5例;正常对照组15名,对病变区域行DWI及常规MRI,测量b=50～1000 s/mm^2时肾脏AML及正常对照组的ADC值。结果肾脏典型AML、不典型AML及正常对照组的ADC值（×10^-3mm^2/s）分别为（0.87±0.08）、（1.55±0.34）、（1.82±0.18）,差异有统计学意义（P〈0.05）。结论3.0T磁共振DWI及ADC值测定可为诊断肾脏AML提供帮助。     

磁共振弥散加权成像在肾脏常见占位性病变中的诊断价值

目的探讨磁共振弥散加权成像在肾脏常见占位性病变中的诊断价值。方法对30例健康志愿者及80例肾脏占位性疾病患者（包括40例肾癌、20例肾错构瘤27个病灶、肾囊肿20例31个病灶）进行常规肾脏磁共振检查及弥散加权成像检查,并在ADC图上直接测量不同b值正常肾脏及病变的平均ADC值。结果 40例肾癌在DWI上表现肿瘤的实质部分表现为高信号,坏死部分呈低信号;20例肾错构瘤DWI表现为境界清楚的混杂信号影,脂肪成分呈低信号;20例肾囊肿DWI上表现为均匀的稍低信号。在b值为500、800、1000s/mm2时,同一b值下正常肾脏、肾癌、肾错构瘤、肾囊肿ADC值存在统计学差异。结论通过DWI及ADC值研究,可以更早更多地了解肿瘤内部结构,有助于肾脏良恶性疾病的诊断与鉴别诊断。     

直肠癌3．0T磁共振弥散加权成像及其与病理的相关性研究

目的 探讨3.0T 磁共振背景抑制弥散加权成像（diffusion-weighted imaging withbackground suppression,DWIBS）对直肠癌的诊断价值,并分析其肿瘤表观弥散系数（apparent diffusioncoefficient,ADC）值与病理的相关关系.方法 收集42 例直肠癌患者术前盆腔常规MRI 及DWI 的扫描资料,所有患者均接受直肠癌切除并病理组织学检查.测量肿瘤及正常直肠肠壁的ADC 值并进行统计学分析.结果 （1）直肠癌组与对照组的ADC 值分别为（0.76 ± 0.11） × 10-3mm2/s 和（1.22± 0.16） × 10-3 mm2/s,两组比较差异有统计学意义（P 〈 0.001）.鉴别直肠癌与正常直肠肠壁的ADC值的最佳分界值为0.96 × 10-3 mm2/s,敏感性为95.2%,特异性为97.6%.（2）1 例高分化,33 例中分化及5 例低分化直肠腺癌的ADC 值分别为0.78 × 10-3 mm2/s,（0.75 ± 0.12） × 10-3 mm2/s 及（0.77 ± 0.11）×10-3 mm2/s.中分化与低分化直肠腺癌的ADC 值比较差异无统计学意义（P 〉 0.05）.结论 3.0T 磁共振DWI 能提高直肠癌的检出率,直肠癌原发灶的ADC 值明显低于正常直肠肠壁的ADC 值,不同分化程度的直肠腺癌的ADC 值间无统计学差异.     

乳腺磁共振扩散成像表观弥散系数值差异的比较研究

目的:通过比较乳腺癌病人健侧乳腺与正常人乳腺及良性病变病人的健侧乳腺的表观弥散系数(apparent diffusion coefficient,ADC)值差异,探讨不同类型乳腺的ADC值差异,绝经后与未绝经者乳腺的ADC值差异,分析不同因素对乳腺ADC值的影响.材料与方法:共84例对象被纳入本研究,全部行磁共振扩散加权成像检查及X线摄片检查.手术或穿刺活检证实39例为乳腺癌病人,45例为正常对照者或乳腺良性病变病人的乳腺,其中已绝经者29例.根据Wolf分型,将84例乳腺分为致密型、分叶串珠型和退化型.扩散敏感系数b值取1 000 s/mm2及600 s/mm2,同时测量乳腺组织的ADC值,进行比较.结果:致密型与退化型乳腺、分叶串珠型与退化型乳腺之间,ADC值差异具有统计学意义;乳腺癌病人健侧乳腺与正常及良性病变病人的健侧乳腺,ADC值差异具有统计学意义;取不同b值时,ADC值差异也具有统计学意义,乳腺ADC值随着b值的增大而减小.结论:ADC值随乳腺类型的不同,及是否曾患乳腺癌而有所变异;ADC值还随行MRI时所采用不同的b值而改变.     

Effects of ursodeoxycholic acid (ursodiol) treatment on chronic viral hepatitis in heart transplant patients: results of a prospective,double-blind,placebo-randomized study

BACKGROUND: Chronic viral hepatitis averages 15% to 20% in heart transplant patients. Several studies have shown that ursodiol may improve liver biochemistry in patients with chronic hepatitis. We used a double-blind randomized controlled trial to evaluate the effect of ursodiol in heart transplant patients with chronic viral hepatitis. METHODS: Thirty heart patients with chronic viral hepatitis B, C, or non-A-G received ursodiol, 800 mg per day (group 1), and 30 received placebo (group 2) for 12 months. Endpoints were improvement in liver biochemical tests and in total Knodell score. Intent-to-treat and per-protocol analyses were performed. RESULTS: At entry, both groups were comparable for all of the studied parameters. During the study period, serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase variations were not different between group 1 and group 2 patients. Knodell score improved in 20% of group 1 patients and in 43% of group 2 patients (NS). Adverse events or mortality were not different in the two groups during the study period. Similar results were observed by intent-to-treat and per-protocol analyses. CONCLUSIONS: A 12-month course of ursodiol therapy had no effect on liver enzymes or liver histology in heart transplant patients with chronic hepatitis.     

声触诊组织量化技术诊断肝纤维化

目的探讨通过超声弹性成像声触诊组织量化（VTQ）技术判断不同分期肝纤维化的价值。方法收集311例慢性乙肝致肝纤维化患者,根据肝纤维化病理分期,分为A组（S1期,161例）、B组（S2期,66例）、C组（S3期,39例）、D组（S4期,45例）;另选100名健康志愿者作为对照组。回顾性分析各组的肝脏超声弹性成像VTQ值。结果 A、B、C、D组及对照组VTQ值分别为（1.41±0.24）m/s、（1.66±0.42）m/s、（2.01±0.60）m/s、（2.44±0.81）m/s、（1.06±0.17）m/s,A、B、C、D组与对照组间差异均有统计学意义（P均〈0.01）,A、B、C、D组间两两比较差异有统计学意义（P均〈0.01）。当VTQ阈值为1.20、1.51、1.60、1.93m/s时,诊断S1期、S2期、S3期及S4期肝纤维化的敏感度、特异度及准确率分别为88.40%、84.02%、93.30%,73.32%、73.91%、79.54%,82.12%、73.11%、84.58%和73.29%、85.33%、85.41%。结论肝脏超声弹性成像VTQ值为判断肝纤维化分期较为准确的指标。     

磁共振成像扩散加权成像技术在鉴别原发性胆囊癌和肝细胞癌中的价值

目的 探讨MRI扩散加权成像(DWI)技术对侵犯肝脏的原发性胆囊癌和侵犯胆囊的原发性肝细胞癌进行鉴别诊断的价值.方法 回顾性分析2009年1月至2010年10月解放军总医院收治的11例原发性胆囊癌和19例原发性肝细胞癌患者的临床资料.采用MRI DWI技术对两种疾病进行鉴别诊断.选择扩散敏感梯度场参数(b值)为800 s/mm2时进行扫描,绘制受试者工作特征曲线(ROC),比较原发性肝细胞癌和原发性胆囊癌的表观弥散系数(ADC)阈值.利用独立样本t检验比较两组ADC值之间的差异.结果 30例患者共30个肿瘤,所有肿瘤在DWI图像上呈高信号,T1WI呈稍低信号,T2WI呈稍高信号,原发性胆囊癌累及肝脏的边界欠清楚.11例原发性胆囊癌患者的肿瘤主要位于胆囊窝区,其中10例累及肝脏,平均ADC值为(0.89±0.14)mm2/s;19例原发性肝细胞癌患者中,15例肿瘤位于肝右叶,4例肿瘤位于肝左叶,平均ADC值为(1.04±0.18)mm2/s,两者ADC值比较,差异有统计学意义(t=2.425,P＜0.05).ROC曲线下面积为0.756(95%CI:0.577～0.935),当阈值为0.96 mm2/s时,敏感性为68.4%,特异性为81.8%.结论 b值为800 s/mm2时,原发性胆囊癌的ADC值低于原发性肝细胞癌,有利于两种疾病的鉴别诊断.

Abstract：

Objective To investigate the value of diffusion-weighted magnetic resonance imaging in the differential diagnosis of primary gallbladder cancer with liver invasion and primary hepatocellular carcinoma (HCC) with gallbladder invasion. Methods From January 2009 to October 2010, 11 patients with primary gallbladder cancer and 19 patients with primary HCC were admitted to the PLA General Hospital. The clinical data of the 30 patients were retrospectively analyzed. All patients underwent diffusion-weighted magnetic resonance imaging with b value of 800 s/mm2, and the receiver operating curve (ROC) was drawn. The apparent diffusion coefficient (ADC) values of the patients with gallbladder cancer and HCC were compared by independent sample t test. Results Thirty tumors were detected in the 30 patients. All tumors showed high signal on DWI, slightly low signal on T1 WI and slightly high signal on T2 WI. The foci of 11 patients with primary gallbladder cancer were at the gallbladder fossa, and 10 of them had liver involvement. The mean ADC value of the 11 patients was (0.89 ±0. 14)mm2/s. Of the 19 patients with primary HCC, the foci of 15 patients were at the right lobe of liver, and 4were at the left lobe. The mean ADC value of the 19 patients was (1.04 ±0.18)mm2/s. There was a significant difference in the ADC value between patients with primary gallbladder cancer and those with primary HCC ( t =2.425, P＜0. 05). The area under the ROC was 0. 756 (95% confidence interval: 0.577-0. 935), and the sensitivity and specificity were 68.4% and 81.8%, respectively, when the threshold value was 0.96 mm2/s.Conclusion The ADC value of patients with primary gallbladder cancer is lower than those with primary HCC when the b value is 800 s/mm2, which is helpful in the differential diagnosis of primary gallbladder cancer and primary HCC.     

Serum Autoantibodies Against Cytochrome P450 2E1 (CYP2E1) Predict Severity of Necroinflammation of Recurrent Hepatitis C

We previously reported that autoantibodies against cytochrome P4502E1 (CYP2E1) are frequent in patients with chronic hepatitis C. As autoimmune reactions are increasingly detected after orthotopic liver transplantation (OLT), this study investigates prevalence and significance of anti-CYP2E1 autoantibodies in 46 patients with post-OLT recurrent hepatitis C.
IgG against recombinant human CYP2E1 above the control threshold was detected in 19 out 46 (41%) sera collected immediately before OLT and in 15 out 46 (33%) sera collected at the time of the 12 months follow-up liver biopsy. Although anti-CYP2E1 reactivity was not modified by OLT, the patients with persistently elevated anti-CYP2E1 IgG (n = 12; 26%) showed significantly higher prevalence of recurrent hepatitis with severe necroinflammation and fibrosis than those persistently negative or positive only either before or after OLT. Moreover, the probability of developing severe necroinflammation was significantly higher in persistently anti-CYP2E1-positive subjects. Multivariate regression and Cox analysis confirmed that the persistence of anti-CYP2E1 IgG, together with a history of acute cellular rejection and donor age >50 years, was an independent risk factor for developing recurrent hepatitis C with severe necroinflammation.
We propose that autoimmune reactions involving CYP2E1 might contribute to hepatic damage in a subgroup of transplanted patients with recurrent hepatitis C.     

磁敏感加权成像评估慢性肝病铁沉积

目的探讨SWI幅度图值评估慢性肝病铁沉积和肝纤维化的可行性及其在诊断慢性肝病中的应用价值。方法对139例慢性肝病患者[慢性肝病组,包括77例慢性肝炎(肝炎亚组)和62例肝硬化(肝硬化亚组)]以及无肝病对照81人(对照组)行常规MR序列及SWI扫描,并采集实验室资料。测量并比较慢性肝病组各亚组与对照组幅度图的肝肌信号强度比(LMR)。ROC曲线分析LMR诊断慢性肝病的效能。比较各组实验室指标和LMR的差异,同时比较不同肝纤维化分级者的LMR。以多元线性回归分析LMR的独立影响因素。结果肝炎亚组、肝硬化亚组和对照组LMR总体差异有统计学意义(P0.001),对照组LMR分别高于肝炎亚组和肝硬化亚组(P均0.01),肝炎亚组LMR高于肝硬化亚组(P=0.002)。ROC曲线分析LMR诊断慢性肝病的敏感度和特异度分别为80.24%和56.13%。不同肝纤维化分级LMR患者差异无统计学意义(P0.05)。肝铁沉积是LMR的独立影响因素(P=0.005)。结论 SWI可初步判断肝脏铁质沉积,诊断慢性肝病具有一定应用价值。     

丙氨酸氨基转移酶正常或轻度升高的慢性乙型肝炎患者抗病毒疗效的影响因素

目的探讨肝组织学、丙氨酸氨基转移酶（ALT）等因素与慢性乙型肝炎抗病毒疗效的相关性。 方法回顾性分析首都医科大学附属北京地坛医院2005至2010年住院行肝组织活检后抗病毒治疗的慢性HBV感染者共81例,采集患者抗病毒治疗基线人口学、生化学、病毒学及肝组织学结果并收集患者抗病毒治疗随访过程中病毒学指标动态下降情况,分析此类患者抗病毒治疗应答相关因素。 结果共纳入患者81例,其中男性60例;平均年龄36.5岁。肝组织学活检提示,肝脏炎症和纤维化≥ G2S2者54例（66.7%）;肝脏炎症和纤维化< G2S2者27例（33.3%）;治疗24周病毒学应答患者63例（77.8%）。肝组织学炎症或纤维化等级、ALT水平及患者平均年龄在抗病毒治疗应答组与无应答组差异均具有统计学意义（P均<0.05）。抗病毒药物类型[干扰素/核苷（酸）类似物]与患者病毒学应答无显著相关。 结论ALT持续正常或轻度异常（< 2 × ULN）的慢性乙型肝炎患者抗病毒疗效与患者肝组织学炎症/纤维化程度及ALT水平显著相关,建议此类患者行肝组织活检以评价抗病毒指征及预测抗病毒疗效。     

Absence of impact of donor hepatic steatosis and posttransplantation lamivudine resistance in a patient with chronic hepatitis B

A patient with chronic hepatitis B underwent liver transplantation for end-stage cirrhosis. The donor liver graft had moderate steatosis and fibrosis. He was placed on lamivudine for hepatitis B prophylaxis but developed viral relapse due to emergence of a lamivudine-resistant mutant at week 72 posttransplantation. Results of liver biochemistry were normal liver histology revealed minimal steatosis and inflammation at weeks 151 and 128, respectively. This report illustrates that the use of a steatotic donor liver and the emergence of lamivudine resistance posttransplantation are not necessarily associated with significant graft damage. A marginal donor graft can be considered due to the donor shortage. Lamivudine monoprophylaxis for hepatitis B virus-related liver diseases post liver transplantation can be used in areas where hepatitis B immunoglobulin is not affordable.     

Early histologic changes in fibrosing cholestatic hepatitis C.

Recurrent hepatitis C (RHCV) after liver transplantation is almost universal, and occasional patients will have an aggressive course characterized histologically by pericellular/sinusoidal fibrosis and cholestasis, known as fibrosing cholestatic hepatitis (FCH). The early stages and evolution of this disease have not been well characterized. A total of 77 liver biopsies performed for indication (nonprotocol) were evaluated for necroinflammation, rejection, cholestasis, and fibrosis. Control groups were composed of protocol biopsies from HCV transplant patients (10 biopsies) as well as non-HCV transplant patients (6 biopsies). Scoring for necroinflammation, rejection, and fibrosis were compiled using standard criteria (hepatic activity index, Banff, Ishak, METAVIR). Pericellular fibrosis was staged with a novel "sinusoidal" system. A cholestasis scoring system was developed to quantitate parenchymal and portal features of cholestasis. Biopsies were categorized as rejection, RHCV, FCH, and stable based on histology and clinical information. FCH was found to have a higher fibrosis stage overall when compared to most diagnostic groups, regardless of the staging system used. Additionally, sinusoidal fibrosis was significantly higher in the FCH diagnosis group. Cholestasis was more prominent in biopsies of FCH in all comparisons. In conclusion, the presence of cholestasis and fibrosis with mild to moderate RHCV should raise the suspicion of FCH. When studying the evolution of these cases, the first abnormality to appear is RHCV and cholestasis, fibrosis develops soon after, and both continue to worsen until the point of allograft failure or patient death.