Department of Gastroenterology, Hepatology and Endocrinology, Medical School, Hannover, Germany.
Ann Hepatol. 2010 Apr-Jun;9(2):181-5.
Liver transplantation (OLT) for primary biliary cirrhosis (PBC) is characterized by disease recurrence of up to one third of patients. The diagnosis of recurrence requires a cholestatic profile and a typical histology representing a challenge for transplant hepatologists. Antimitochondrial antibodies (AMA) establish the initial diagnosis, persist after OLT, and are thus of limited value for the diagnosis of recurrence. Aim of this analysis was to identify serological parameters associated with recurrent PBC.
OLT performed between 1992 and 2006 at Hannover Medical School were evaluated retrospectively including histology before and after OLT, autoimmune serological parameters and clinical characteristics.
Between 1992 and 2006 72 patients underwent OLT with histologically confirmed PBC. Median follow up was 123 months. AMA persisted in 55 (76%) patients. Anti-parietal cell antibodies (PCA) were detectable in 41% of the patients before and 47% after OLT. Liver biopsies were obtained in 34 patients post OLT upon clinical suspicion, and recurrent PBC diagnosed in 28% after a mean of 71 months (range 13-161). Anti-PCA were detected in 100% of patients with recurrence before and following transplantation, 54% of patients with anti-PCA before OLT developed recurrence during follow-up. There were no differences in immunosuppressive regimen.
Although unspecific for the diagnosis of PBC, anti-PCA prevalence increased after OLT, and was 100% in patients with recurrent PBC. Recurrent PBC developed in 54% of patients with anti-PCA before OLT suggesting a diagnostic role of anti-PCA as a simple and cost effective marker of recurrence.
原发性胆汁性肝硬化（PBC）的肝移植（OLT）的特点是多达三分之一的患者出现疾病复发。复发的诊断需要胆汁淤积的特征和代表移植肝病学家的挑战的典型组织学。抗线粒体抗体（AMA）确立了初始诊断，在 OLT 后持续存在，因此对复发的诊断价值有限。本分析的目的是确定与复发性 PBC 相关的血清学参数。
回顾性评估了 1992 年至 2006 年在汉诺威医学院进行的 OLT，包括 OLT 前后的组织学、自身免疫血清学参数和临床特征。
1992 年至 2006 年间，72 例经组织学证实的 PBC 患者接受了 OLT。中位随访时间为 123 个月。55 例（76%）患者 AMA 持续存在。41%的患者在 OLT 前和 47%的患者在 OLT 后可检测到抗壁细胞抗体（PCA）。在 34 例 OLT 后因临床怀疑而获得肝活检，平均随访 71 个月（范围 13-161）后诊断为复发性 PBC。复发患者在移植前后均可检测到抗 PCA，54%的 OLT 前有抗 PCA 的患者在随访期间出现复发。免疫抑制方案没有差异。
尽管抗 PCA 对 PBC 的诊断不特异，但在 OLT 后其患病率增加，并且在复发性 PBC 患者中为 100%。OLT 前有抗 PCA 的患者中有 54%发生复发性 PBC，提示抗 PCA 作为复发的简单且具有成本效益的标志物具有诊断作用。
