Nakhleh R E, Sutherland D E
Department of Pathology, Henry Ford Hospital, Detroit, Michigan 48202.
Am J Surg Pathol. 1992 Nov;16(11):1098-107.
To determine the significance of various histopathologic features of pancreatic rejection, we reviewed the pathology of 53 biopsies taken to rule out rejection [32 bladder drained, (BD); 18 non-BD]. Twenty-six biopsies from 23 patients with allografts which ultimately failed (FLD) (7 BD, 16 non-BD) were compared with 27 biopsies from 27 patients with allografts which continue to function (FXN) (25 BD, 2 non-BD). The groups are similar in regard to age, sex, and time after transplant to biopsy. The mean follow-up is 13 months for FLD grafts versus 35 months for FXN grafts (p < 0.0001). In BD grafts, decreases in urine amylase usually led to biopsy, while in non-BD grafts, hyperglycemia usually prompted biopsy. More patients with ultimately FLD organs (17 of 26) presented with elevated blood glucose (BG) than patients with FXN grafts (2 of 27) (p < 0.0001). Multiple histologic features were examined related to the acinar tissue, pancreatic ducts, islets, vessels, and nerves. Features which strongly correlated with a negative outcome included moderate to severe inflammation of acinar tissue (p < 0.0001), acinar tissue loss and fibrosis (p < 0.0087) and vascular luminal narrowing due to chronic rejection (p < 0.003). Twenty-one pancreases showed chronic rejection and were treated with OKT3 or anti-lymphocytic globulin (ALG), six of these continue to function 1.6-9 years after biopsy, including two who presented with elevated BG levels. A normal biopsy was found in nine pancreases, all of which continue to function. Vasculitis was only seen in biopsies with moderate to severe inflammation, whereas endothelialitis was also seen in association with mild inflammation, suggesting that vasculitis is a more aggressive lesion. A rejection classification is proposed with endothelialitis partly defining mild rejection and vasculitis defining severe rejection. We conclude that several biopsy features and elevation of BG are strongly correlated with a high probability of failure; however, antirejection therapy is justified because recovery of function occurs in some cases. A normal biopsy obviates the need for therapy and predicts a good outcome, as do mild histological findings of rejection.
为了确定胰腺排斥反应各种组织病理学特征的意义，我们回顾了53例为排除排斥反应而进行活检的病理情况[32例膀胱引流式（BD）；18例非BD]。将23例移植器官最终失功（FLD）患者的26份活检标本（7例BD，16例非BD）与27例移植器官仍在发挥功能（FXN）患者的27份活检标本（25例BD，2例非BD）进行比较。两组在年龄、性别以及移植至活检的时间方面相似。FLD移植物的平均随访时间为13个月，而FXN移植物为35个月（p<0.0001）。在BD移植物中，尿淀粉酶降低通常会导致活检；而在非BD移植物中，高血糖通常促使进行活检。最终移植器官失功的患者（26例中的17例）出现血糖（BG）升高的情况比FXN移植物患者（27例中的2例）更多（p<0.0001）。对与腺泡组织、胰管、胰岛、血管和神经相关的多种组织学特征进行了检查。与不良结局密切相关的特征包括腺泡组织中度至重度炎症（p<0.0001）、腺泡组织丢失和纤维化（p<0.0087）以及慢性排斥导致的血管腔狭窄（p<0.003）。21例胰腺显示慢性排斥，并接受了OKT3或抗淋巴细胞球蛋白（ALG）治疗，其中6例在活检后1.6至9年仍在发挥功能，包括2例出现BG水平升高的患者。9例胰腺活检结果正常，所有这些胰腺仍在发挥功能。血管炎仅在中度至重度炎症的活检中可见，而内皮炎也可见于轻度炎症的情况，这表明血管炎是一种更具侵袭性的病变。提出了一种排斥反应分类方法，以内皮炎部分定义轻度排斥，血管炎定义重度排斥。我们得出结论，几种活检特征和BG升高与高失功概率密切相关；然而，抗排斥治疗是合理的，因为在某些情况下功能会恢复。活检结果正常无需治疗，并预示良好结局，轻度排斥的组织学表现也是如此。
