Park Y N, Boros P, Zhang D Y, Sheiner P, Kim-Schluger L, Thung S N
Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea.
Arch Pathol Lab Med. 2000 Nov;124(11):1623-7. doi: 10.5858/2000-124-1623-SHCVRL.
Histopathologic features of early recurrent hepatitis C after orthotopic liver transplantation (OLTx) may be modified by immunosuppressive therapy or complicated by other conditions. Hepatitis C virus (HCV) RNA level usually increases after OLTx, but its correlation to histologic findings is not clear.
To evaluate the histologic findings of early recurrent hepatitis C in liver allografts and its correlation to serum HCV RNA level.
We studied 14 patients who underwent OLTx for chronic HCV infection. Thirty liver biopsy specimens and HCV RNA levels of 22 corresponding plasma samples obtained during the first 6 months following OLTx were analyzed. The control group (9 patients, 25 biopsy specimens) was chosen at random from patients with chronic liver disease other than HCV who were undergoing OLTx, and all tested negative for HCV RNA by polymerase chain reaction after OLTx.
Statistically significant pathological features of early recurrent HCV infection were the number of acidophilic bodies, piecemeal necrosis, lymphocyte predominance in the portal tracts, and fibrous septum. These findings and histologic activity index scores increased with time after OLTx. The HCV RNA levels determined by branched DNA assay showed no significant correlation with histologic features. However, patients with higher histologic activity index scores tended to have higher RNA levels.
Liver biopsy specimens are helpful for the diagnosis or confirmation of early recurrent hepatitis C in liver allografts, but serial biopsy specimens are sometimes required for definite diagnosis. The HCV RNA levels are usually higher in patients who display signs of more severe liver damage.
原位肝移植（OLTx）后早期复发性丙型肝炎的组织病理学特征可能会因免疫抑制治疗而改变，或并发其他病症。肝移植后丙型肝炎病毒（HCV）RNA水平通常会升高，但其与组织学结果的相关性尚不清楚。
评估肝移植中早期复发性丙型肝炎的组织学表现及其与血清HCV RNA水平的相关性。
我们研究了14例因慢性HCV感染接受原位肝移植的患者。分析了肝移植后前6个月内获取的30份肝活检标本以及22份相应血浆样本的HCV RNA水平。对照组（9例患者，25份活检标本）从接受原位肝移植的非HCV慢性肝病患者中随机选取，且所有患者肝移植后通过聚合酶链反应检测HCV RNA均为阴性。
早期复发性HCV感染具有统计学意义的病理特征为嗜酸性小体数量、桥接坏死、汇管区淋巴细胞为主以及纤维间隔。这些表现和组织学活动指数评分随肝移植后的时间增加。通过分支DNA检测法测定的HCV RNA水平与组织学特征无显著相关性。然而，组织学活动指数评分较高的患者往往RNA水平也较高。
肝活检标本有助于诊断或确认肝移植中早期复发性丙型肝炎，但有时需要系列活检标本才能明确诊断。表现出更严重肝损伤迹象的患者HCV RNA水平通常更高。
