移植肝穿刺活检268例次病理学观察

目的 研究肝移植术后移植肝多种并发症的临床发生情况、病理学特征和活检诊断作用.方法 收集1999年1月至2011年5月华中科技大学同济医学院附属同济医院器官移植研究所207例受者共268次经皮移植肝穿刺活检组织予以HE、Masson及PAS染色和补体C4d、乙型肝炎病毒表面抗原(HBsAg)、乙型肝炎病毒核心抗原(HBcAg)、丙型肝炎病毒(HCV)、巨细胞病毒(CMV)、细胞角蛋白(CK)19免疫组化染色并予以病理学观察分析.结果 268例次移植肝活检中,缺血/再灌注损伤26例次(9.7％)、急性T细胞介导性排斥反应83例次(31.0％)、急性抗体介导性排斥反应12例次(4.5％)、慢性排斥反应31例次(11.6％)、药物性肝损伤70例次(26.1％)、复发性肝病18例次(6.7％).结论 肝移植术后可发生多种并发症并可通过活检病理学观察予以明确诊断,肝移植临床中应常规开展移植肝穿刺活检病理学诊断.

Histopathological study of 268 hepatic allograft biopsies

Objective To observe the histopathological features of posttransplant complications for hepatic allografts and evaluate their biopsy values.Methods From January 1999 to May 2011,a total of 268 percutaneous hepatic allograft biopsies were conducted in 207 recipients and the diagnostic procedures for staining,classification and staging performed according to the Banff schema and Chinese Schema on hepatic allograft rejection. Results Among them,there were ischemia/reperfusion injury ( n =26,9.7％ ),acute T cell-mediated rejection ( n =83,31.0％ ),acute antibody-mediated rejection ( n =12,4.5％ ),chronic posttransplantation rejection (n =31,11.6％ ),immunosuppressive-induced liver injury (n =70,26.1％ )and recurrent diseases (n =18,6.7％ ). Acute T cell-mediated rejection and druginduced liver injury were two most common causes of allograft dysfunctions. Conclusion Percutaneous hepatic allograft biopsy is valuable for the diagnosis and evaluation of various posttransplantation complications.