Richter Andrea, Grabhorn Enke, Helmke Knut, Manns Michael P, Ganschow Rainer, Burdelski Martin
Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Pediatric Gastroenterology and Hepatology, Hamburg, Germany.
Clin Transplant. 2007 May-Jun;21(3):427-32. doi: 10.1111/j.1399-0012.2007.00667.x.
The presence of autoantibodies and development of autoimmune hepatitis after liver transplantation has recently been reported as one of the causes for chronic graft dysfunction. The pathogenesis and clinical significance of this disease still remains unclear.
We evaluate 96 patients for the prevalence of autoantibodies and autoimmune hepatitis after pediatric liver transplantation and review their clinical follow-up including virus serologies, ultrasound examination and liver biopsies.
Positive autoantibodies were detected in 74% of the patients after pediatric OLT. Graft dysfunction was observed in 46% of these children, and in 35% of the transplant recipients seronegative for autoantibodies. None of the patients showed histological signs or fulfilled clinical criteria for de novo autoimmune hepatitis. One child with negative autoantibodies was diagnosed to have a histologically proven de novo AIH two yr following OLT.
There is a high prevalence of autoantibodies after pediatric OLT, but the incidence of de novo AIH is very rare. In transplant recipients showing elevated liver function tests de novo autoimmune hepatitis has to be excluded by liver biopsy even if the patient is seronegative for autoantibodies.
肝移植后自身抗体的出现及自身免疫性肝炎的发生最近被报道为慢性移植物功能障碍的原因之一。该病的发病机制和临床意义仍不清楚。
我们评估了96例小儿肝移植患者自身抗体和自身免疫性肝炎的患病率，并回顾了他们的临床随访情况，包括病毒血清学、超声检查和肝活检。
小儿原位肝移植术后74%的患者检测到自身抗体阳性。这些儿童中有46%出现移植物功能障碍，自身抗体血清学阴性的移植受者中有35%出现移植物功能障碍。没有患者表现出组织学征象或符合新发自身免疫性肝炎的临床标准。一名自身抗体阴性的儿童在肝移植术后两年被诊断为经组织学证实的新发自身免疫性肝炎。
小儿肝移植术后自身抗体患病率很高，但新发自身免疫性肝炎的发生率非常低。在肝功能检查结果升高的移植受者中，即使患者自身抗体血清学阴性，也必须通过肝活检排除新发自身免疫性肝炎。
