Zhang Y, Wang B, Wang T
Liver Research Center, Beijing Friendship Hospital, Beijing, China.
Transplant Proc. 2010 Nov;42(9):3854-7. doi: 10.1016/j.transproceed.2010.08.062.
De novo autoimmune hepatitis (AIH) occurred in patients who underwent liver transplantation for a different etiology. This 55-year-old woman was transplanted due to PBC. One year after liver transplantation, she complained of fatigue. Liver function tests showed markedly elevated serum alanine transaminase (ALT) and globulin levels. She also tested positive for anti-nuclear antibodies (ANA). Liver biopsy showed lymphocytic and plasmacytic infiltration in the portal and periportal areas, with numerous areas of bridging centrilobular necrosis, indicating AIH. She had a pretreatment AIH score of 16 points, and a posttreatment score of 18 points according to the scoring system of the International AIH Group (IAHG). The patient was treated effectively with prednisone, but then suffered two further episodes of AIH as a result of decreasing the prednisone dose. Histological features on liver biopsy were similar to those on initial presentation. Treatment with prednisone and azathioprine resulted in a dramatically improved outcome. Her liver function and globulin levels rapidly returned to normal and have remained so thereafter.
新发自身免疫性肝炎（AIH）发生在因其他病因接受肝移植的患者中。这位55岁的女性因原发性胆汁性胆管炎（PBC）接受了肝移植。肝移植一年后，她主诉疲劳。肝功能检查显示血清丙氨酸转氨酶（ALT）和球蛋白水平显著升高。她的抗核抗体（ANA）检测也呈阳性。肝活检显示门静脉和门静脉周围区域有淋巴细胞和浆细胞浸润，并有多处桥接性小叶中心坏死，提示为AIH。根据国际自身免疫性肝炎小组（IAHG）的评分系统，她治疗前的AIH评分为16分，治疗后的评分为18分。该患者接受泼尼松治疗有效，但随后因泼尼松剂量减少又出现了两次AIH发作。肝活检的组织学特征与初次表现相似。泼尼松和硫唑嘌呤治疗取得了显著改善的结果。她的肝功能和球蛋白水平迅速恢复正常，并此后一直保持正常。
