98例肝移植患者术后肝穿刺活检标本组织病理学分析

 【目的】对98例肝移植（OLTx）患者术后肝穿刺活检病理资料进行回顾性分析，探讨OLTx术后各种并发症的组织形态学表现，提高移植病理诊断水平。【方法】收集361例OLTx患者病例资料，其中98例OLTx患者术后因肝功能异常行肝穿刺活检，常规HE染色以及HBsAg、HBc、HCV、CMV免疫组化染色。部分病例行CK19免疫组化染色。【结果】98例患者共行肝穿刺129次，结果急性排斥反应最常见，共计42例（42．86％），其余为慢性排斥反应2例（2．04％），缺血一再灌注损伤8例（8．16％），胆道并发症21例（21．43％），血管并发症6例（6．12％），药物性肝损害3例（3．06％），肝炎病毒感染及肝炎复发8例（8．16％），CMV感染3例（3．06％），肝癌复发2例（2．04％），难以诊断3例（3．06％）。【结论】移植肝穿刺活检对移植术后并发症的诊断及鉴别诊断具有重要价值，可为临床选择治疗方案提供重要依据。

Pathologic Diagnosis of Transplantation Liver Puncture Biopsy: Histopathologic Analysis of 98 Cases

Objective To explore the histological morphological features of complications following orthotopic liver transplantation(OLTx) and improve the level of pathologic diagnosis.Methods All cases of post-transplantation liver biopsies were analyzed by using routine HE staining,and combined with immunohistochemical detection,including HBsAg,HBcAg,HCV,CMV,and CK19.Hepatic allograft rejection was determined according to Banff standard and scored with rejection activity index(RAI).Results A total of 129 times of liver biopsies in 98 cases were performed.Acute cellular rejection was most commonly seen in 42 cases(42.86%),and chronic rejection,ischemia-reperfusion injury,complication of biliary tract,complication of blood vessel,drug-induced damage,recurrence of hepatitis,CMV infection and recurrence of liver cancer were also found in 2(2.04%),8(8.16 %),21(21.43 %),6(6.12%),3(3.06%),8(8.16%),3(3.06 %),and 2(2.04%) cases.Otherwise 3 cases of liver biopsies were unable to be diagnosed exactly by the above methods.Conclusion Percutaneous liver biopsy is valuable for the diagnosis of complications and selection of suitable treatments and should be proposed to use routinely after OLTx.