Khettry Urmila, Backer Amy, Ayata Gamze, Lewis W David, Jenkins Roger L, Gordon Fredric D
Department of Pathology, Lahey Clinic Medical Center, Burlington, MA, USA.
Hum Pathol. 2002 Mar;33(3):270-6. doi: 10.1053/hupa.2002.32225.
We evaluated centrilobular histologic changes seen on post-orthotopic liver transplantation (OLT) biopsies to refine the pathologic diagnosis by systematic study of morphologic and clinical data with possible identification of prognostic criteria. A total of 110 biopsies with zone 3 pathology from 59 patients were reviewed and correlated with clinical findings. Within the first 6 months post-OLT (group I), 39 of 47 patients had combinations of centrilobular hepatocytic dropout, ballooning, and cholestasis on single or multiple biopsies attributed to perioperative ischemic/perfusion injury; 12 of 39 patients with all 3 features present had increased incidence of biliary complications and sepsis and decreased 1-year patient and graft survival; 17 of 39 patients with 2 of the 3 features had increased biliary complications but not decreased 1-year survival; and the remaining 8 of 47 patients had central venulitis associated with acute cellular rejection. After 6 months post-OLT (group II), 14 patients, including 2 from group I, had biopsies with centrilobular pathology; 8 of 14 had central venulitis related to rejection (acute, 4; chronic, 4), and fibrosis was seen in 8 (rejection, 6; cardiac problems, 2). In conclusion, combinations of centrilobular hepatocytic ballooning, dropout, and cholestasis are seen in association with reversible or irreversible ischemic/perfusion damage in the early post-OLT period. The presence of all 3 features is associated with a poor outcome. Central venulitis as a feature of acute/chronic rejection is seen at any time post-OLT and is not a predictor of poor graft/patient survival.
我们评估了原位肝移植（OLT）术后活检中观察到的小叶中心组织学变化，通过系统研究形态学和临床数据来完善病理诊断，并可能确定预后标准。回顾了59例患者的110份具有3区病理变化的活检标本，并将其与临床结果相关联。在OLT术后的前6个月内（I组），47例患者中的39例在单次或多次活检中出现小叶中心肝细胞脱落、气球样变和胆汁淤积的组合，这归因于围手术期缺血/灌注损伤；39例具有所有这3种特征的患者中，12例发生胆道并发症和脓毒症的发生率增加，1年患者和移植物存活率降低；39例具有这3种特征中的2种特征的患者中，17例发生胆道并发症增加，但1年存活率未降低；47例患者中的其余8例患有与急性细胞排斥相关的中央静脉炎。OLT术后6个月后（II组），14例患者（包括I组中的2例）进行了具有小叶中心病理变化的活检；14例中的8例患有与排斥相关的中央静脉炎（急性，4例；慢性，4例），8例出现纤维化（排斥，6例；心脏问题，2例）。总之，小叶中心肝细胞气球样变、脱落和胆汁淤积的组合在OLT术后早期与可逆或不可逆的缺血/灌注损伤相关。所有3种特征的存在与不良预后相关。中央静脉炎作为急性/慢性排斥的特征在OLT术后任何时间都可见，并且不是移植物/患者存活率低的预测指标。
