Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
Transplantation. 2010 Mar 27;89(6):739-48. doi: 10.1097/TP.0b013e3181c96b32.
Patients with established liver grafts may receive excessive immune suppression. Liver biopsies were analyzed in those with normal liver biochemistry to identify parameters that might identify such cases.
Patients with established grafts (>3 years from engraftment) and normal liver biochemistry (normal alanine transaminase, alkaline phosphatase, and bilirubin) were invited to undergo liver biopsy. Liver tissue was assessed by routine histopathology, a modified Ishak score, and immunohistochemistry for lymphocyte and cell-cycle markers. Circulating and intrahepatic lymphocytes were subjected to flow cytometry. Data were subjected to principal component analysis.
Two hundred twenty-five (40%) patients under regular review had an established graft with normal liver biochemistry; liver tissue was obtained in 55. Liver histology was normal in eight cases (14.5%). The most common abnormalities were mild nonspecific hepatitis in 25 (45.4%) and disease recurrence in 14 (25.4%). Principal component analysis identified a cluster of variables that accounted for a significant degree of variation within the dataset. These were lobular inflammation, portal inflammation, interface hepatitis, and fibrosis.
Inflammation persisted in established grafted livers in most patients with normal liver biochemistry. Systematic histological and lymphocyte phenotype analysis generated an index that distinguished patient groups. Those with least inflammation and the lowest alanine transaminase may have a reduced requirement for immune suppression.
已建立的肝移植物的患者可能会接受过度的免疫抑制。对那些具有正常肝功能的患者进行肝活检分析，以确定可能识别这些病例的参数。
邀请具有已建立移植物（> 3 年）和正常肝功能（正常丙氨酸转氨酶、碱性磷酸酶和胆红素）的患者进行肝活检。通过常规组织病理学、改良 Ishak 评分和淋巴细胞和细胞周期标志物的免疫组织化学评估肝组织。对循环和肝内淋巴细胞进行流式细胞术分析。对数据进行主成分分析。
225 名（40%）定期接受复查的患者具有正常肝功能的已建立移植物；55 名患者获得了肝组织。8 例（14.5%）肝组织学正常。最常见的异常是轻度非特异性肝炎 25 例（45.4%）和疾病复发 14 例（25.4%）。主成分分析确定了一组变量，这些变量在数据集内解释了很大程度的变化。这些变量包括小叶炎症、门脉炎症、界面肝炎和纤维化。
在大多数具有正常肝功能的已建立移植肝脏患者中，炎症仍然存在。系统的组织学和淋巴细胞表型分析产生了一个区分患者组的指标。那些炎症和丙氨酸转氨酶最低的患者可能需要减少免疫抑制的需求。
