Batts K P, Moore S B, Perkins J D, Wiesner R H, Grambsch P M, Krom R A
Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Transplantation. 1988 Feb;45(2):376-9. doi: 10.1097/00007890-198802000-00026.
Among the first 52 recipients of primary liver allografts with follow-up of 2 weeks or greater, 6 patients had biopsy-confirmed vanishing bile duct syndrome (VBDS) and required retransplantation. Five of these six patients had positive lymphocyte crossmatches. Of the 46 remaining liver transplant recipients, 11 had positive crossmatches. Thus, the incidence of VBDS was 5/16 in recipients with a positive crossmatch and 1/36 in recipients with a negative crossmatch. The positive-crossmatch group was significantly more likely to develop VBDS than the negative-crossmatch group (P less than 0.004, log rank test). Additional HLA studies comparing degree of donor-recipient mismatch at the various HLA loci showed no significant difference between the groups for class I disparity. However, class II mismatch was of borderline significance (P less than 0.056). When evaluated individually, the DQ mismatch (P less than 0.04) appeared to be more important than the DR mismatch (P = NS). Our data suggest that a positive lymphocyte crossmatch and a class II mismatch, in particular HLA DQ disparity, may play an important role in the pathogenesis of VBDS.
在首批52例接受同种异体原位肝移植且随访时间达2周或更长时间的患者中，6例经活检确诊为胆管消失综合征（VBDS）并需要再次移植。这6例患者中有5例淋巴细胞交叉配型呈阳性。在其余46例肝移植受者中，11例交叉配型呈阳性。因此，交叉配型阳性的受者中VBDS的发生率为5/16，交叉配型阴性的受者中VBDS的发生率为1/36。交叉配型阳性组比交叉配型阴性组发生VBDS的可能性显著更高（P<0.004，对数秩检验）。进一步比较供受者在各个HLA位点错配程度的HLA研究表明，两组在I类错配上无显著差异。然而，II类错配具有临界显著性（P<0.056）。单独评估时，DQ错配（P<0.04）似乎比DR错配（P=无显著性差异）更重要。我们的数据表明，淋巴细胞交叉配型阳性和II类错配，尤其是HLA DQ错配，可能在VBDS的发病机制中起重要作用。
