Chiu King-Wah, Chen Yaw-Sen, de Villa Vanessa H, Wang Chih-Chi, Eng Hock-Liew, Wang Shih-Hor, Liu Por-Ping, Jawan Bruno, Huang Tung-Liang, Cheng Yu-Fan, Chen Chao-Long
Liver Transplant Program, Division of Hepato-Gastroenterology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan.
Hepatogastroenterology. 2005 Nov-Dec;52(66):1825-7.
BACKGROUND/AIMS: To determine the biochemical data that reliably predict allograft injury from acute rejection (AR) in patients with living related liver transplantation (LRLT), liver function test and histopathological characteristics of AR were compared and analyzed retrospectively.
From Aug. 1994 to Nov. 2000, 101 cases received orthotopic liver transplantation (OLT), which included 53 patients with LRLT in our series. Completed liver functions including aspartate transferase (AST), alanine transferase (ALT), bilirubin total/direct (Bil.T/D), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) were collected with peak level when AR was diagnosed by liver biopsy. The best data of the same patients when disease free, were compared and analyzed with non-parametric Wilcoxon signed ranks test and Mann-Whitney test. All of the ARs were reversed with steroid pulse therapy, and two cases converted to FK506. No steroid-resistant rejection or chronic rejection was found in our series.
In the patients with LRLT, 17 episodes in 13 patients with AR were found. The incidence of histological analysis proved AR was 12.9% (13/101) in OLT and 24.5% (13/53) in LRLT respectively. Among the liver function tests, AST (p<0.0001), ALT (p<0.0001), Bil.T (p=0.001), Bil.D (p=0.001), GGT (p<0.0001), and INR (p=0.034) were the significant predictors respectively in the patients with AR episode. Once liver enzymes had elevated, the AST/ALT ratio <1.0 showed a more significant difference in AR than in those of the no rejection group (p<0.0001). ALP showed significant difference in our series. The severity of histological change was not correlated to the degree of liver enzymes elevation.
Complete liver function tests especially AST, ALT, Bil.T/D, GGT and the ratio of AST/ALT are very sensitive tests in a group of patients receiving LRLT with AR. The severity of AR is based on the histopathologic change but is not related to the degree of liver enzymes elevation itself. Meanwhile, the outcome of acute rejection in living related liver transplantation is quite good.
背景/目的：为了确定能够可靠预测活体亲属肝移植（LRLT）患者急性排斥反应（AR）所致同种异体移植物损伤的生化数据，对肝功能检查结果和AR的组织病理学特征进行回顾性比较和分析。
1994年8月至2000年11月，101例患者接受了原位肝移植（OLT），其中53例为LRLT。当通过肝活检诊断为AR时，收集包括天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、总胆红素/直接胆红素（Bil.T/D）、碱性磷酸酶（ALP）和γ-谷氨酰转肽酶（GGT）在内的完整肝功能指标的峰值水平。采用非参数Wilcoxon符号秩检验和Mann-Whitney检验对同一患者在无疾病时的最佳数据进行比较和分析。所有AR均通过类固醇冲击疗法逆转，2例改用FK506。本研究系列中未发现类固醇抵抗性排斥反应或慢性排斥反应。
在LRLT患者中，13例发生AR的患者出现了17次发作。组织学分析证实OLT中AR的发生率分别为12.9%（13/101），LRLT中为24.5%（13/53）。在肝功能检查中，AST（p<0.0001）、ALT（p<0.0001）、Bil.T（p=0.001）、Bil.D（p=0.001）、GGT（p<0.0001）和国际标准化比值（INR，p=0.034）分别是AR发作患者的显著预测指标。一旦肝酶升高，AST/ALT比值<1.0在AR患者中显示出比无排斥反应组更显著的差异（p<0.0001）。ALP在本研究系列中显示出显著差异。组织学改变的严重程度与肝酶升高程度无关。
在接受LRLT且发生AR的患者组中，完整的肝功能检查，尤其是AST、ALT、Bil.T/D、GGT以及AST/ALT比值，是非常敏感的检测指标。AR的严重程度基于组织病理学改变，但与肝酶升高程度本身无关。同时，活体亲属肝移植中急性排斥反应的预后相当良好。
