Department of Immunology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain.
Digestive and Liver Diseases Service, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain.
World J Gastroenterol. 2018 Aug 7;24(29):3239-3249. doi: 10.3748/wjg.v24.i29.3239.
Antibody-mediated rejection (AMR) in liver transplantation has long been underestimated. The concept of the liver as an organ susceptible to AMR has emerged in recent years, not only in the context of the major histocompatibility complex with the presence of HLA donor-specific antibodies, but also with antigens regarded as "minor", whose role in AMR has been demonstrated. Among them, antibodies against glutathione S-transferase T1 have been found in 100% of patients with autoimmune hepatitis (dnAIH) when studied. In its latest update, the Banff Working Group for liver allograft pathology proposed replacing the term dnAIH with plasma cell (PC)-rich rejection. Antibodies to glutathione S-transferase T1 (GSTT1) in null recipients of GSTT1 positive donors have been included as a contributory but nonessential feature of the diagnosis of PC-rich rejection. Also in this update, non-organ-specific anti-nuclear or smooth muscle autoantibodies are no longer included as diagnostic criteria. Although initially found in a proportion of patients with PC-rich rejection, the presence of autoantibodies is misleading since they are not disease-specific and appear in many different contexts as bystanders. The cellular types and proportions of the inflammatory infiltrates in diagnostic biopsies have been studied in detail very recently. PC-rich rejection biopsies present a characteristic cellular profile with a predominance of T lymphocytes and a high proportion of PCs, close to 30%, of which 16.48% are IgG4. New data on the relevance of GSTT1-specific T lymphocytes to PC-rich rejection will be discussed in this review.
肝移植中的抗体介导的排斥反应（AMR）长期以来一直被低估。近年来，人们逐渐认识到肝脏是一种易受 AMR 影响的器官，不仅在主要组织相容性复合体（MHC）存在 HLA 供体特异性抗体的情况下如此，而且在被认为是“次要”的抗原的情况下也是如此，这些抗原在 AMR 中的作用已得到证实。其中，在研究自身免疫性肝炎（dnAIH）时，在 100%的患者中发现了针对谷胱甘肽 S-转移酶 T1（GSTT1）的抗体。在其最新更新中，肝移植病理学班夫工作组提议用富含浆细胞（PC）的排斥反应取代 dnAIH 这一术语。在 GSTT1 阳性供体的 GSTT1 阴性受者中，针对 GSTT1 的抗体被纳入富含 PC 排斥反应诊断的辅助但非必需特征。在本次更新中，非器官特异性抗核或平滑肌自身抗体也不再作为诊断标准。虽然最初在富含 PC 的排斥反应患者中发现了这些抗体，但它们的存在具有误导性，因为它们不是疾病特异性的，并且在许多不同的情况下作为旁观者出现。最近，详细研究了诊断性活检中炎症浸润的细胞类型和比例。富含 PC 的排斥反应活检表现出特征性的细胞特征，以 T 淋巴细胞为主，PC 比例高，接近 30%，其中 16.48%为 IgG4。关于 GSTT1 特异性 T 淋巴细胞与富含 PC 的排斥反应相关性的新数据将在本综述中讨论。
