Nakhleh R E, Krishna M, Keaveny A P, Dickson R C, Rosser B, Nguyen J H, Steers J L
Mayo Clinic Jacksonville, Jacksonville, Florida 32256, USA.
Transplant Proc. 2005 Mar;37(2):1240-2. doi: 10.1016/j.transproceed.2004.12.113.
We examined the clinical and pathologic features of morphologic hepatitis occurring after liver transplantation (LT) that is unrelated to disease recurrence.
Between February 1998 and December 2003, 704 primary LTs were performed at our center. Patients transplanted for diagnoses with low risk of disease recurrence were considered for our study (n = 282). Those with hepatitis C (HCV), hepatitis B (HBV), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH) were excluded. Those with morphologic hepatitis comprised our case series and had medical records reviewed for clinical associations, duration, and outcome.
Thirty-one cases were identified. They were transplanted for cryptogenic cirrhosis (n = 13), steatohepatitis (n = 12), alpha-1-antitrypsin deficiency (n = 3), tumor (n = 2), and acetaminophen toxicity (n = 1); 22 cases (67%) presented within the first 8 months post-LT (range, 0.5-72 months). Histological activity was mild in 19 and moderate in 12. Associated conditions were identified in 19 patients (57%) with 3 categories being identified: probable drug toxicity (n = 7), systemic infection (n = 4), and mechanical or hemodynamic abnormalities (n = 8). Of the 25 cases that underwent follow-up biopsy 2 to 32 months (mean, 15.5 months) after the index biopsy, 10 cases had resolution and 15 cases had persistence of the infiltrate. One patient had evidence of de novo HBV infection.
Morphologic hepatitis occurred in 11% of patients at low risk for disease recurrence. Associated conditions could be grouped into three categories: drug toxicity, systemic infection, and mechanical or hemodynamic factors. Most cases did not appear to progress or improved over time, with no allograft loss occurring as a result of chronic hepatitis.
我们研究了肝移植（LT）后发生的与疾病复发无关的形态学肝炎的临床和病理特征。
1998年2月至2003年12月期间，我们中心进行了704例原位肝移植。本研究纳入疾病复发风险较低的移植患者（n = 282）。排除丙型肝炎（HCV）、乙型肝炎（HBV）、原发性胆汁性肝硬化（PBC）、原发性硬化性胆管炎（PSC）和自身免疫性肝炎（AIH）患者。形态学肝炎患者构成我们的病例系列，并对其病历进行回顾，以了解临床关联、病程和结局。
共识别出31例。他们因隐源性肝硬化（n = 13）、脂肪性肝炎（n = 12）、α-1抗胰蛋白酶缺乏症（n = 3）、肿瘤（n = 2）和对乙酰氨基酚毒性（n = 1）而接受移植；22例（67%）在肝移植后的前8个月内出现（范围为0.5 - 72个月）。组织学活动度轻度的有19例，中度的有12例。19例患者（57%）发现有相关情况，分为3类：可能的药物毒性（n = 7）、全身感染（n = 4）以及机械或血流动力学异常（n = 8）。在首次活检后2至32个月（平均15.5个月）接受随访活检的25例患者中，10例炎症消退，15例浸润持续存在。1例患者有新发HBV感染的证据。
疾病复发风险较低的患者中有11%发生了形态学肝炎。相关情况可分为三类：药物毒性、全身感染以及机械或血流动力学因素。大多数病例似乎未随时间进展或有所改善，未因慢性肝炎导致移植肝丢失。
