Vasuri Francesco, Malvi Deborah, Gruppioni Elisa, Grigioni Walter F, D'Errico-Grigioni Antonia
Francesco Vasuri, Deborah Malvi, Elisa Gruppioni, Walter F Grigioni, Antonia D'Errico-Grigioni, "F. Addarii" Institute of Oncology and Transplantation Pathology, S. Orsola-Malpighi Hospital, Bologna University, 40138 Bologna, Italy.
World J Gastroenterol. 2014 Mar 21;20(11):2810-24. doi: 10.3748/wjg.v20.i11.2810.
Although the morphological features of hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) have been well established in the last decades, the differential diagnosis still represents a challenge for the pathologist, especially early recurrent hepatitis C vs mild acute cellular rejection. The present review focuses on the role of the pathologist and the pathology laboratory in the management of recipients with recurrent hepatitis C, the usefulness of early and late post-OLT liver biopsies, and the potential role of ancillary techniques (immunohistochemistry and reverse transcription-polymerase chain reaction, RT-PCR). The English literature on the topic is reviewed, focusing on the histopathology, the immunohistochemistry and the use of RT-PCR on HCV-positive post-OLT biopsies. The different histopathological illustrations of early and chronic recurrent hepatitis C are presented, with special focus on the main differential diagnoses and those features with prognostic relevance (cholestasis above all). The usefulness of ancillary techniques are discussed, especially HCV RNA quantitation by RT-PCR. Finally, the usefulness of long-term protocol biopsies is addressed: their usefulness for the study of allograft disease progression is clear, but their meaning in the long term is still debated. The significance of plasma cell infiltrate in HCV-positive allografts, the prognostic weight of graft steatosis, and the impact of donor age in recurrent hepatitis C also represent additional open issues.
尽管在过去几十年中，原位肝移植（OLT）后丙型肝炎病毒（HCV）复发的形态学特征已得到充分确立，但鉴别诊断对病理学家来说仍然是一项挑战，尤其是早期复发性丙型肝炎与轻度急性细胞排斥反应的鉴别。本综述重点关注病理学家和病理实验室在复发性丙型肝炎受者管理中的作用、OLT术后早期和晚期肝活检的有用性以及辅助技术（免疫组织化学和逆转录聚合酶链反应，RT-PCR）的潜在作用。本文回顾了关于该主题的英文文献，重点关注组织病理学、免疫组织化学以及RT-PCR在OLT术后HCV阳性活检中的应用。展示了早期和慢性复发性丙型肝炎的不同组织病理学表现，特别关注主要的鉴别诊断以及那些具有预后相关性的特征（尤其是胆汁淤积）。讨论了辅助技术的有用性，特别是通过RT-PCR进行HCV RNA定量。最后，探讨了长期方案活检的有用性：其对研究移植物疾病进展的有用性是明确的，但从长期来看其意义仍存在争议。浆细胞浸润在HCV阳性移植物中的意义、移植物脂肪变性的预后权重以及供体年龄对复发性丙型肝炎的影响也都是尚未解决的问题。
