Baas Marjolein, Gouw Annette S H, van den Heuvel Marius C, Hepkema Bouke G, Peeters Paul M G J, Verkade HenkJan, Scheenstra René
Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Pediatr Transplant. 2017 Nov;21(7). doi: 10.1111/petr.12988. Epub 2017 Jun 18.
In the majority of long-term survivors after PLTx, graft fibrosis has been identified. Recently, subtypes of graft fibrosis have been described based on their predominant acinar localization. We aimed to evaluate whether the development of portal, perisinusoidal, and centrilobular distribution of graft fibrosis is related to patient or transplantation-related parameters. We reviewed the histological features in protocol liver biopsies taken at 1 and 5 years after PLTx of 47 children on a tacrolimus-based immunosuppressive regimen. Fibrosis was assessed according to the LAFSc. The prevalence of portal fibrosis increased from 31% to 62%, sinusoidal from 68% to 79%, and centrilobular from 76% to 85%. The presence of portal fibrosis was associated with total bilirubin and γGT levels (each P<.02) and tended to be associated with biliary complications (P=.06). Sinusoidal fibrosis was associated with prior rejection episodes (P<.02) and centrilobular fibrosis with the presence of HLA mismatches (P=.02). In conclusion, using the LAFSc, we found a high incidence of progressive fibrosis in the 1-year and 5-year protocol biopsies after PLTx. Progression of fibrosis was observed in all acinar compartments, and each of the three locations is associated with different clinical conditions.
在大多数活体肝移植（PLTx）后的长期存活者中，已发现移植物纤维化。最近，根据移植物纤维化的主要腺泡定位描述了其亚型。我们旨在评估移植物纤维化的门管区、窦周和小叶中心分布的发展是否与患者或移植相关参数有关。我们回顾了47例接受基于他克莫司的免疫抑制方案的儿童在PLTx后1年和5年时进行的方案肝活检的组织学特征。根据洛杉矶纤维化评分系统（LAFSc）评估纤维化情况。门管区纤维化的发生率从31%增至62%，窦周纤维化从68%增至79%，小叶中心纤维化从76%增至85%。门管区纤维化的存在与总胆红素和γ-谷氨酰转移酶（γGT）水平相关（均P<0.02），并且倾向于与胆道并发症相关（P=0.06）。窦周纤维化与既往排斥反应相关（P<0.02），小叶中心纤维化与HLA错配的存在相关（P=0.02）。总之，使用LAFSc，我们发现在PLTx后的1年和5年方案活检中进行性纤维化的发生率很高。在所有腺泡区均观察到纤维化进展，并且这三个位置中的每一个都与不同的临床情况相关。
