肝移植后复发性自身免疫性肝炎和新诊断的自身免疫性肝炎。

Recurrent Autoimmune Hepatitis and De Novo Autoimmune Hepatitis in the Liver Allograft.

机构信息

Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.

Department of Pathology, Yale School of Medicine, New Haven, CT.

出版信息

Am J Clin Pathol. 2021 Feb 11;155(3):435-445. doi: 10.1093/ajcp/aqaa147.

DOI:10.1093/ajcp/aqaa147

PMID:33252121

Abstract

OBJECTIVES

Autoimmune hepatitis (AIH) is a form of severe hepatitis that can recur after orthotopic liver transplant (OLT). Presentation of AIH in patients with OLT who do not have a history of AIH is called de novo AIH (DNAIH). We evaluated the clinicopathologic characteristics of AIH and DNAIH.

METHODS

Clinicopathologic and outcome measures of 11 patients with recurrent AIH (RAIH) and 22 with DNAIH identified between 2000 and 2017 were compared.

RESULTS

Both cohorts showed female predominance. The mean clinical follow-up was 13 and 7.8 years in the in the RAIH and DNAIH groups, respectively (P = .1). Moderate portal inflammation was more common in patients with RAIH (64% vs 27%, P = .043). A trend was observed for more cases of DNAIH showing severe inflammation (36% vs 9%, P = .09) and submassive necrosis compared with RAIH (23% vs 0%, P = .086). A trend for more advanced fibrosis was also noted in the RAIH group (27% vs 5%, P = .059). Three patients with RAIH lost their grafts because of RAIH. Five-year disease-specific graft survival (GS) (P = .012) and overall GS (P = .015) were worse in patients with RAIH. Complement component 4d immunohistochemistry was positive in 2 patients with RAIH and 3 with DNAIH but showed no correlation with GS or other parameters.

CONCLUSIONS

RAIH seems to have a more aggressive clinical course than DNAIH and warrants closer clinical follow-up and aggressive treatment.

摘要

目的

自身免疫性肝炎（AIH）是一种严重的肝炎形式，在肝移植（OLT）后可能会复发。OLT 后没有 AIH 病史的患者出现 AIH 称为新发自身免疫性肝炎（DNAIH）。我们评估了 AIH 和 DNAIH 的临床病理特征。

方法

比较了 2000 年至 2017 年间确诊的 11 例复发 AIH（RAIH）和 22 例 DNAIH 患者的临床病理和预后指标。

结果

两组均以女性为主。RAIH 组和 DNAIH 组的平均临床随访时间分别为 13 年和 7.8 年（P =.1）。RAIH 患者中更常见中度门脉炎症（64% vs 27%，P =.043）。DNAIH 组有更多严重炎症（36% vs 9%，P =.09）和亚大块坏死的病例（23% vs 0%，P =.086），呈趋势性。RAIH 组也有更多的晚期纤维化（27% vs 5%，P =.059）。3 例 RAIH 患者因 RAIH 失去移植物。RAIH 患者的 5 年疾病特异性移植物存活率（GS）（P =.012）和总 GS（P =.015）均较差。2 例 RAIH 和 3 例 DNAIH 患者的补体成分 4d 免疫组化阳性，但与 GS 或其他参数无相关性。