Demirhan Beyhan, Bilezikçi Banu, Haberal A Nihan, Sevmiş Sinasi, Arat Zübeyde, Haberal Mehmet
Department of Pathology, Baskent University School of Medicine, Bahçelievler, Ankara, Turkey.
Liver Transpl. 2008 Feb;14(2):214-9. doi: 10.1002/lt.21360.
During the first episode of acute cellular rejection (ACR) after liver transplantation, centrilobular changes in liver biopsy specimens may be possible indicators of subsequent episodes of ACR, early chronic rejection, or acute graft loss. The purpose of this study was to identify differences between the histopathological findings in liver biopsy specimens obtained during the first rejection episode in patients who subsequently developed further episodes of ACR and those who did not. The histopathological findings in 22 patients who had a single episode of acute rejection (group 1) were compared with those in 23 patients who had multiple episodes of acute rejection (group 2). Only the first liver biopsy samples of the latter group were taken into consideration. We assessed the predictive value of centrilobular necrosis, central vein endothelialitis, pericentral inflammation, hepatocellular ballooning, cholestasis, hepatocellular apoptosis, lobular inflammation, the degree of portal eosinophilia, and characteristic portal tract features in poor responders to antirejection treatment. The time to the first episode of ACR and the rejection activity index were similar in patients in both groups. Hepatocellular apoptosis, hepatocellular ballooning, and central vein endothelialitis were common features of both groups. The incidences of pericentral inflammation, centrilobular necrosis, and portal eosinophilia were significantly higher in patients in group 2 than in those in group 1 (P < 0.05). Patients with pericentral inflammation, centrilobular necrosis, and marked portal eosinophilia during an initial episode of acute rejection may be more likely to develop subsequent episodes of ACR.
在肝移植后的首次急性细胞排斥反应（ACR）期间，肝活检标本中的小叶中心改变可能是后续ACR发作、早期慢性排斥反应或急性移植物丢失的潜在指标。本研究的目的是确定在随后发生进一步ACR发作的患者和未发生进一步ACR发作的患者中，首次排斥反应发作期间获得的肝活检标本的组织病理学发现之间的差异。将22例发生单次急性排斥反应的患者（第1组）的组织病理学发现与23例发生多次急性排斥反应的患者（第2组）的组织病理学发现进行比较。仅考虑后一组的首次肝活检样本。我们评估了小叶中心坏死、中央静脉内皮炎、中央周围炎症、肝细胞气球样变、胆汁淤积、肝细胞凋亡、小叶炎症、门脉嗜酸性粒细胞增多程度以及抗排斥治疗反应不佳者的特征性门管区特征的预测价值。两组患者首次发生ACR的时间和排斥反应活动指数相似。肝细胞凋亡、肝细胞气球样变和中央静脉内皮炎是两组的共同特征。第2组患者中央周围炎症、小叶中心坏死和门脉嗜酸性粒细胞增多的发生率显著高于第1组患者（P < 0.05）。在急性排斥反应初始发作期间出现中央周围炎症、小叶中心坏死和明显门脉嗜酸性粒细胞增多的患者可能更有可能发生后续的ACR发作。
