供受者血型不合肝移植2例病理观察

解放军南京军区福州总医院收治2例血型不合肝移植患者，病例1：患者男，因“原发性肝癌”在全麻下行经典式原位肝移植，供体血型为A型，受体为O型。病例2：患者女，患乙型肝炎病史，因“妊娠合并重症肝病，凝血功能障碍”行经典式原位肝移植，供体血型为B型，受体为O型。免疫组织化学染色后光镜下观察2例供受体血型不合肝移植的病理改变以及肝组织中各种免疫球蛋白和补体的沉积情况；探讨移植肝体液排异反应的诊断标准。结果显示2例移植肝的肝血窦内皮细胞上有不同程度IgG、IgM、IgA、C4c、C4d和C1q线状或颗粒状沉积，提示IgG等免疫球蛋白在肝窦内皮细胞上弥漫强阳性沉积，并伴有C4d等补体成分表达，可作为移植肝组织中存在体液排异反应的证据。

Pathological characteristics of two patients following liver transplantation of blood type incompatibility

Two patients underwent liver transplantation of blood type incompatibility were collected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. Case 1: A male who had primary hepatic carcinoma underwent classic orthotopic liver transplantation; the blood of donor was type A, and the blood of recipient was type O. Case 2: A female having history of type B hepatitis underwent classic orthotopic liver transplantation due to pregnancy combining with severe liver disease and coagulation disorder; the blood of donor was type B, and the blood of recipient was type O. Immunohistochemistry staining was used to observe pathological changes and deposition of various immunoglobulin and complement in two cases following liver transplantation of blood type incompatibility under optic microscope and to investigate diagnostic standard of humoral rejection. The results showed that linear or granular depositions of IgG, IgM, IgA, C4c, C4d, and C1q were found in endothelial cells of hepatic sinusoid, suggesting that IgG and other immunoglobulin exhibited a strongly positively diffused deposition on the endothelial cells of hepatic sinusoid, while expression of C4d and other complements was also found. All those mentioned above could be considered as evidences to prove onset of humoral rejection in transplanted liver tissue.