Rai R M, Boitnott J, Klein A S, Thuluvath P J
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Clin Gastroenterol. 2001 Feb;32(2):151-4. doi: 10.1097/00004836-200102000-00012.
Recurrence of primary sclerosing cholangitis (PSC) after liver transplantation is very uncommon. The true incidence of recurrence is unknown, mainly because of the difficulty in differentiating ischemic strictures from that of recurrent disease. Primary sclerosing cholangitis and ischemic strictures have identical histopathologic and cholangiographic features. We report a young man who had recurrence of PSC in two allografts and report our experience in 32 patients who had liver transplantation for PSC. Six patients (18%) had evidence of non-anastomotic strictures and, of these, only one patient (reported here) had unequivocal evidence of true recurrence. The strictures in other five patients happened because of ischemia. The recurrence of the disease in two allografts in an immunosuppressed patient, in the absence of ischemia, chronic rejection, or any known pathogen, raises the question of the role of an unidentified infectious agent in the etiopathogenesis of PSC.
肝移植后原发性硬化性胆管炎（PSC）复发极为罕见。复发的真实发生率尚不清楚，主要是因为难以区分缺血性狭窄与复发性疾病。原发性硬化性胆管炎和缺血性狭窄具有相同的组织病理学和胆管造影特征。我们报告了一名年轻男性，其两个同种异体移植肝均出现PSC复发，并报告了我们对32例因PSC接受肝移植患者的经验。6例患者（18%）有非吻合口狭窄的证据，其中只有1例患者（本文报告）有明确的真正复发证据。其他5例患者的狭窄是由缺血引起的。一名免疫抑制患者在无缺血、慢性排斥反应或任何已知病原体的情况下，两个同种异体移植肝均出现疾病复发，这引发了关于一种未识别的感染因子在PSC发病机制中作用的问题。
