Washington Kay
Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Adv Anat Pathol. 2005 Jul;12(4):221-6. doi: 10.1097/01.pap.0000175113.55541.9c.
Complications of liver transplantation are not limited to acute and chronic rejection, and recurrence of original disease, but include surgical complications, most commonly hepatic artery occlusion, infections, and development of de novo malignancies. In the early posttransplantation period, procurement/preservation injury, non-immunologic injury to the graft during harvesting and implantation, is manifested by centrilobular hepatocyte pallor and cholestasis but rarely leads to significant graft dysfunction. Ischemic complications, such as hepatic artery thrombosis, are more serious complications and may lead to early graft loss or biliary stricture. Infectious complications generally occur in the mid-to-late period after transplantation; cytomegalovirus (CMV) remains a common pathogen. Human herpes 6 virus infection has been implicated in allograft dysfunction, but is usually seen in the setting of co-infection with CMV. De novo malignancies are emerging as a significant cause of mortality after liver transplantation; risk is cumulative, and increases with time posttransplantation. Development of such malignancies in the setting of solid organ transplantation is multifactorial, and is related to individual and regional predispositions to malignancy, pre-transplantation disease states, recipient viral status, and use and intensity of immunosuppression regimens.
肝移植的并发症不仅限于急性和慢性排斥反应以及原发病复发，还包括手术并发症，最常见的是肝动脉闭塞、感染以及新发恶性肿瘤。在移植后的早期，获取/保存损伤，即移植肝在获取和植入过程中的非免疫性损伤，表现为小叶中心肝细胞苍白和胆汁淤积，但很少导致严重的移植肝功能障碍。缺血性并发症，如肝动脉血栓形成，是更严重的并发症，可能导致早期移植肝丢失或胆管狭窄。感染性并发症通常发生在移植后的中晚期；巨细胞病毒（CMV）仍然是常见的病原体。人类疱疹病毒6型感染与移植肝功能障碍有关，但通常见于与CMV合并感染的情况。新发恶性肿瘤正成为肝移植后死亡的一个重要原因；风险是累积性的，并且随着移植后时间的推移而增加。实体器官移植时此类恶性肿瘤的发生是多因素的，并且与个体和区域的恶性肿瘤易感性、移植前疾病状态、受者病毒状态以及免疫抑制方案的使用和强度有关。
