Doria C, di Francesco F, Marino I R, Ramirez C B, Frank A, Iaria M, Galati S A, Farber J L
Department of Transplant Surgery Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Transplant Proc. 2006 Dec;38(10):3597-600. doi: 10.1016/j.transproceed.2006.10.175.
Cirrhosis secondary to chronic hepatitis C virus (HCV) is the most common indication for liver transplantation. Recurrence of HCV infection in the liver allograft occurs at a high rate. The differentiation of recurrent HCV infection from acute cellular rejection (ACR) represents a difficult challenge in transplantation pathology. The c-Kit receptor is a tyrosine kinase membrane protein encoded by the c-Kit proto-oncogene, which is expressed on mast cells and on hematopoietic stem and progenitor cells. Mast cells are important effector cells of a broad range of immune responses. Recently, c-Kit+ mast cells were shown to form part of the inflammatory infiltrate in acute liver allograft rejection. A strong relationship was found between c-Kit+ cell densities and increasingly severe rejection. The present study sought to determine whether the presence of c-Kit+ cells could be used to distinguish between ACR and recurrent HCV in liver allografts. Immunohistochemical staining for c-Kit was performed on 20 transplant biopsy specimens from 10 patients with mild to moderate ACR and 10 other patients with recurrent hepatitis C. The number of c-Kit+ cells per portal tract varied with the density of the overall inflammatory infiltrate. There was no significant difference between the number of c-Kit+ cells in the biopsy specimens that carried a diagnosis of ACR and those from patients who had been diagnosed as having recurrent HCV. It was concluded that immunohistochemical staining for the presence of c-Kit+ mast cells cannot be used to differentiate between ACR and recurrent HCV infection in liver allograft biopsy specimens.
慢性丙型肝炎病毒（HCV）继发的肝硬化是肝移植最常见的适应症。肝移植中HCV感染复发率很高。区分复发性HCV感染与急性细胞排斥反应（ACR）是移植病理学中的一项难题。c-Kit受体是一种由c-Kit原癌基因编码的酪氨酸激酶膜蛋白，在肥大细胞以及造血干细胞和祖细胞上表达。肥大细胞是广泛免疫反应的重要效应细胞。最近发现，c-Kit+肥大细胞是急性肝移植排斥反应中炎性浸润的一部分。发现c-Kit+细胞密度与排斥反应日益严重之间存在密切关系。本研究旨在确定c-Kit+细胞的存在是否可用于区分肝移植中的ACR和复发性HCV。对10例轻度至中度ACR患者和10例复发性丙型肝炎患者的20份移植活检标本进行了c-Kit免疫组化染色。每个门管区c-Kit+细胞的数量随整体炎性浸润的密度而变化。诊断为ACR的活检标本与诊断为复发性HCV的患者的活检标本中c-Kit+细胞的数量没有显著差异。得出的结论是，不能用c-Kit+肥大细胞存在的免疫组化染色来区分肝移植活检标本中的ACR和复发性HCV感染。
