Lawal A, Florman S, Fiel M I, Gordon R, Bromberg J, Schiano T D
Department of Liver Diseases and Transplantation, The Mount Sinai Medical Center, New York, New York 10029, USA.
Transplant Proc. 2005 Dec;37(10):4339-42. doi: 10.1016/j.transproceed.2005.10.095.
Primary nonfunction (PNF) after liver transplantation is fatal without timely retransplantation. PNF has been associated with many risk factors, but the etiology remains unknown in most cases. Using electron microscopy, we examined the hepatic ultrastructure of donor allografts in patients experiencing PNF and compared the findings with a well-matched group of other donor allografts.
Archival paraffin-embedded pre- and post-reperfusion donor liver biopsies were examined by electron microscopy in 10 patients with PNF and in 10 controls, matched by donor age +/- 5 years, gender, cold ischemic time +/- 1 hour, and donor cause of death. Mitochondria, endoplasmic reticulum, sinusoidal endothelial cells, and the glycogen content of the cells were assessed. The donors' serum peak transaminases, bilirubin and sodium levels, as well as the recipient age and serum creatinine were compared.
There were no significant differences in recipient age at the time of transplantation, peak recipient serum creatinine, donor peak serum transaminase, sodium or bilirubin levels. In all cases, the endoplasmic reticulum and sinusoidal endothelial cells were ultrastructurally normal. Hepatocytes had variable degrees of glycogen pooling. Hepatic steatosis and intramitochondrial inclusions cells were present in 5/10 PNF compared to 0/10 controls patients on preperfusion liver biopsy (P = .17).
Liver allografts from patients suffering from PNF can have mitochondrial ultrastructural changes on preperfusion biopsies.
肝移植后的原发性无功能（PNF）若不及时再次移植会导致死亡。PNF与许多风险因素相关，但在大多数情况下病因仍不明。我们利用电子显微镜检查了发生PNF患者的供体同种异体移植物的肝脏超微结构，并将结果与一组匹配良好的其他供体同种异体移植物进行比较。
对10例PNF患者和10例对照者的存档石蜡包埋的供肝再灌注前后活检组织进行电子显微镜检查，对照者按供体年龄±5岁、性别、冷缺血时间±1小时以及供体死亡原因进行匹配。评估线粒体、内质网、肝血窦内皮细胞以及细胞内糖原含量。比较供体血清转氨酶峰值、胆红素和钠水平，以及受者年龄和血清肌酐。
移植时受者年龄、受者血清肌酐峰值、供体血清转氨酶峰值、钠或胆红素水平无显著差异。在所有病例中，内质网和肝血窦内皮细胞超微结构正常。肝细胞有不同程度的糖原蓄积。与10例对照患者中0例相比，10例PNF患者中有5例在再灌注前肝活检时存在肝脂肪变性和线粒体内包涵体细胞（P = 0.17）。
发生PNF患者的肝脏同种异体移植物在再灌注前活检时可出现线粒体超微结构改变。
