Batts K P
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
Liver Transpl Surg. 1999 Jul;5(4 Suppl 1):S21-9. doi: 10.1053/JTLS005s00021.
Hepatic allograft rejection has been divided into humoral (or hyperacute), acute (or cellular), and chronic (or ductopenic) forms. Humoral rejection is extremely uncommon in the liver and is not graded. Acute rejection will occur in approximately 50% of liver allografts, is more common in the first few weeks posttransplantation, and is defined by Snover's triad of portal hepatitis, endothelialitis (or endotheliitis), and lymphocytic cholangitis. This form of rejection is generally reversible, either spontaneously or with additional immunosuppressive therapy, and can be reliably graded using a system with categories of mild, moderate, and severe rejection, associated with 37%, 48%, and 75% unfavorable shortterm and 1%, 12%, and 14% unfavorable long-term outcomes, respectively. Chronic rejection is characterized histologically by progressive duct loss and a lipid-rich vasculopathy that can be difficult to diagnose in early phases. Chronic rejection typically occurs several months to a year posttransplantation, although exceptions exist.
肝移植排斥反应分为体液性（或超急性）、急性（或细胞性）和慢性（或胆管减少性）几种类型。体液性排斥反应在肝脏中极为罕见，且不进行分级。急性排斥反应大约会发生在50%的肝移植受者中，在移植后的头几周更为常见，其定义为Snover三联征，即门管区肝炎、内皮炎（或血管内皮炎）和淋巴细胞性胆管炎。这种排斥反应通常是可逆的，可自发逆转或通过额外的免疫抑制治疗逆转，并且可以使用轻度、中度和重度排斥反应分类系统进行可靠分级，分别与37%、48%和75%的短期不良结局以及1%、12%和14%的长期不良结局相关。慢性排斥反应的组织学特征是进行性胆管丧失和富含脂质的血管病变，早期可能难以诊断。慢性排斥反应通常发生在移植后数月至一年，不过也有例外情况。
