Randhawa P, Blakolmer K, Kashyap R, Raikow R, Nalesnik M, Demetris A J, Jain A
Division of Transplantation Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Am J Surg Pathol. 2001 Mar;25(3):324-30. doi: 10.1097/00000478-200103000-00006.
Allograft liver biopsy specimens (n = 24) obtained in the clinical setting of primarily extrahepatic posttransplant lymphoproliferative disease (PTLD) were studied for histopathology, lymphocyte subsets, and Epstein-Barr virus (EBV)-encoded EBER RNA. Acute rejection was found in 20 (83.3%) of 24 biopsy specimens and graded as indeterminate in 7 (35%) of 20 (35%), mild in 3 (15%) of 20, and moderate in 10 (50%) of 20 cases. EBV hepatitis was the primary diagnosis in two biopsy specimens and a secondary finding in six others. Four biopsy specimens showed nonspecific reactive hepatitis, and five showed recurrence of primary liver disease. Immunoperoxidase staining showed primarily T cells. EBER RNA was detected in 14 (58.3%) of 24 biopsy specimens: 12 (60%) of 20 with and 2 (50%) of 4 without acute rejection. Antirejection therapy resulted in complete or partial response in 4 (36.3%) of 11 and 7 (63.7%) of 11 treated cases, respectively, despite the presence of EBV-infected cells in some tissues. Subsequent follow-up showed early or late chronic rejection in 6 (25%) of 24 patients. Gamma glutamyl transferase, a marker for early or late chronic rejection, was greater than five times the upper limit of normal in 9 (37.5%) of 24 patients. In conclusion, liver biopsy specimens in patients with PTLD show a spectrum of pathologic changes. Rejection may be treated even if EBV is concurrently present. Long-term graft is suboptimal, because low immunosuppression results in a tendency to develop chronic rejection.
对在主要为肝外移植后淋巴细胞增生性疾病（PTLD）临床情况下获取的24份同种异体肝活检标本进行了组织病理学、淋巴细胞亚群和爱泼斯坦 - 巴尔病毒（EBV）编码的EBER RNA研究。24份活检标本中有20份（83.3%）发现急性排斥反应，其中20份中有7份（35%）分级为不确定，20份中有3份（15%）为轻度，20份中有10份（50%）为中度。EBV肝炎是两份活检标本的主要诊断，另外六份为次要发现。四份活检标本显示非特异性反应性肝炎，五份显示原发性肝病复发。免疫过氧化物酶染色主要显示T细胞。24份活检标本中有14份（58.3%）检测到EBER RNA：20份有急性排斥反应的标本中有12份（60%），4份无急性排斥反应的标本中有2份（50%）。尽管某些组织中存在EBV感染细胞，但抗排斥治疗分别使11例治疗患者中的4例（36.3%）和7例（63.7%）获得了完全或部分缓解。随后的随访显示，24例患者中有6例（25%）出现早期或晚期慢性排斥反应。γ-谷氨酰转移酶是早期或晚期慢性排斥反应的标志物，24例患者中有9例（37.5%）高于正常上限的五倍。总之，PTLD患者的肝活检标本显示出一系列病理变化。即使同时存在EBV，排斥反应也可治疗。长期移植物情况欠佳，因为低免疫抑制会导致发生慢性排斥反应的倾向。
