脑死亡供体肝脏病理改变及临床移植应用评估的探讨

目的 探讨脑死亡供体肝脏病理改变及对临床移植应用的指导意义.方法 对23例脑死亡供体肝脏进行活检,做HE染色、PASM染色、网染(快速超声波处理)及电镜检察.结果 光镜下发现23例肝细胞均有不同程度的浊肿变性,但病变区域均＜50％；3例见灶性肝脂肪变性,22例肝小叶结构、界板、汇管区多无著变,1例炎症细胞浸润明显.电镜下主要改变为线粒体肿胀及内质网扩张.选择22个肝脏对6例肝硬化、16例肝癌患者施行了移植,手术均获成功.21例受者的国际标准化比值术后快速下降,7d左右恢复正常,于术后20～30 d顺利出院.随访5-24个月,其中1例术后9个月因肝内胆管结石肝功能衰竭再次行肝移植术,2例肝癌患者分别于术后13、15个月复发,失访,余肝功能正常.1例乙肝肝硬化爆发肝功能衰竭患者术后8d死于重症肺部感染及消化道出血术.结论 脑死亡供肝若肝细胞无明显坏死、浊肿＜50％、脂肪化＜30％、无纤维化、汇管区无明显改变可以作为移植供体.

Pathological changes and transplantation assessments of the liver from brain-death donor

Objective Investigation of pathological changes of the liver from brain-dead donor, and its indication value for clinical liver transplantation. Methods Liver biopsy and analysis were performed for 23 cases of brain-dead donors, included HE staining, PASM staining, net staining of fast ultrasonic sections and electron microscope observation. Results Cloudy swellings were observed for all of 23 cases, but the diseased regions were all less than 50%. Focus liked steatosis was observed in 3 cases, while no significant changes were founded in hepatic lobule, limiting plate and header region. 1 case was founded had obvious inflammatory cell infiltration, and the main changes under the electron microscope were mitochondrial swelling and endoplasmic reticulum expansion. Liver transplantation operations were successfully performed in 22 cases. Conclusion No obvious necrosis of liver cells,cloudy swelling liver cells were less than 50%, steatosis of liver cells were less than 30%, no fibration, and no significant changes in header region of the liver from brain-dead donor should be used as standard indicators suitable transplantation.