再次同种异体原位肝移植的临床及病理研究

目的 探讨肝移植术后肝脏的病理组织学变化特点及其临床病理意义.方法 回顾性分析2002-2006年期间实施的15例再次肝移植受者的临床资料,对15例再次肝移植切除的全肝标本进行病理组织学观察分析.结果 15例再次肝移植存活者占53.3%,死亡者中严重感染占57.1%.病理组织学变化以慢性排斥反应和胆管、血管狭窄、阻塞为主.慢性排斥反应占20%,胆管病变占46.6%,血管病变占33.3%.结论 再次肝移植存活者较首次肝移植者低,死亡原因主要是严重感染.导致再次肝移植的多种原因中,肝胆管、血管狭窄、阻塞的发生相对较慢性排斥反应高,且移植后肝脏胆管和血管病变常并存.肝胆管、血管狭窄、阻塞是导致再次肝移植的重要原因.早诊断、早治疗是提高再次肝移植成功的关键,应引起高度重视.

Clinicopathological study of second-time orthotopic liver transplantation

Objective To study the pathological change features of donor liver and their clinical usefulness after liver transplantation.Methods The clinical data of patients receiving liver transplantation in our hospital between 2002 and 2006 were retrospectively analyzed to observe the histopathological changes of excised whole donor liver tissues sampled from 15 cases of orthotopic liver retransplantation.Results rvival of the retransplanted patients in 15 cases was 53.3% and 57.1% of death cases related to severe infection (sepsis).The bistopathological changes of the retransplanted liver tissues were mainly reflected by chronic rejection and the obstruction and dysfunction of bile duct and blood vessel.The occurring rate of chronic rejection was 20%,the rate of pathological changes in bile duct was 46.6% and that in blood vessel was 33.3%.Conclusion The patients receiving second-time liver transplantation have a lower rate of survival than those receiving the first-time one.The most frequent cause of death is severe infection.The possibility of having obstruction and dysfunction of bile duct and blood vessel is higher than chronic rejection.After transplantation,the pathological changes in bile duct and blood vessel will be presented.The obstruction and dysfunction of bile duct and blood vessel are crucial causes to induce liver retransplantation.Starting to diagnose and treat as soon as possible is important to improve successful rate of liver retransplantation.So close attention should be paid on this issue.