隐源性肝硬化、酒精性肝病、丙型肝炎及胆汁淤积性肝病肝移植后的同种异体移植肝组织学比较

Comparative allograft histology after liver transplantation for cryptogenic cirrhosis, alcohol, hepatitis C, and cholestatic liver diseases.

作者信息

Maor-Kendler Y, Batts K P, Burgart L J, Wiesner R H, Krom R A, Rosen C B, Charlton M R

机构信息

Mayo Clinic and Foundation, Rochester, MN 55905, USA.

出版信息

Transplantation. 2000 Jul 27;70(2):292-7. doi: 10.1097/00007890-200007270-00009.

DOI:10.1097/00007890-200007270-00009

PMID:10933151

Abstract

BACKGROUND

End-stage liver disease for which no cause can be identified, cryptogenic cirrhosis, is a common indication for liver transplantation. Allograft inflammation and fibrosis have been reported to recur with similar frequencies after liver transplantation for cryptogenic cirrhosis and hepatitis C (HCV).

METHODS

We determined sequential posttransplant allograft histology in four groups of recipients: 31 transplanted for cryptogenic cirrhosis, 70 for cholestatic etiologies, 40 for alcoholic liver disease, and 56 for HCV. Modified hepatitis activity index (HAI) and fibrosis stage were determined at 4 months, 1 year, and at most recent biopsy posttransplantation.

RESULTS

The prevalence of HAI > or = 2 among cryptogenic recipients was similar to that of cholestatic and alcoholic recipients at 4 months, 1 year, and at most recent evaluation (mean 45+/-17 months posttransplantation). For HCV-infected recipients, the frequency of HAI > or = 2 was more than for cryptogenic recipients at 1 year (52 vs. 29%, P=0.04) and at most recent evaluation (64 vs. 15%, P=0.003). Fibrosis scores for cryptogenic, cholestatic, and alcoholic recipients were similar at all timepoints. The proportion of HCV-infected recipients with fibrosis stage >2 was more than that of cryptogenic recipients at 4 months (29 vs. 12%, P=0.05), 1 years (46 vs. 7%, P=0.0002), and at most recent evaluation (42 vs. 15%, P=0.06). None of the cryptogenic recipients developed cirrhosis.

RESULTS

The frequency of elevated HAI and fibrosis stage in recipients who undergo transplantation for cryptogenic cirrhosis is similar to that of recipients who undergo transplantation for cholestatic etiologies and significantly less than that of HCV-infected recipients. Fibrosis stage and HAI are generally stable after transplantation for cryptogenic cirrhosis. These data do not suggest a viral etiology of liver disease in the majority of patients with cryptogenic cirrhosis.

摘要

背景

无法明确病因的终末期肝病，即隐源性肝硬化，是肝移植的常见适应证。据报道，隐源性肝硬化和丙型肝炎（HCV）患者肝移植后同种异体移植物炎症和纤维化的复发频率相似。

方法

我们确定了四组受者移植后的连续同种异体移植物组织学情况：31例因隐源性肝硬化接受移植，70例因胆汁淤积性病因接受移植，40例因酒精性肝病接受移植，56例因HCV接受移植。在移植后4个月、1年以及最近一次活检时测定改良的肝炎活动指数（HAI）和纤维化分期。

结果

在4个月、1年以及最近一次评估（移植后平均45±17个月）时，隐源性受者中HAI≥2的患病率与胆汁淤积性和酒精性受者相似。对于HCV感染的受者，在1年时（52%对29%，P=0.04）以及最近一次评估时（64%对15%，P=0.003），HAI≥2的频率高于隐源性受者。隐源性、胆汁淤积性和酒精性受者在所有时间点的纤维化评分相似。HCV感染的受者中纤维化分期>2的比例在4个月时（29%对12%，P=0.05）、1年时（46%对7%，P=0.0002）以及最近一次评估时（42%对15%，P=0.06）均高于隐源性受者。隐源性受者均未发展为肝硬化。