Macía Cristina, Loureiro Jose, Campos-Varela Isabel, Abdulkader Ihab, Otero Esteban, Varo Evaristo, Tomé Santiago, Gonzalez-Quintela Arturo
Department of Internal Medicine and Hepatology, Complejo Hospitalario Universitario de Santiago, Santiago, Spain.
Department of Pathology, Complejo Hospitalario Universitario de Santiago, Santiago, Spain.
Case Reports Hepatol. 2020 Nov 30;2020:8895435. doi: 10.1155/2020/8895435. eCollection 2020.
Under normal conditions, adult hepatocytes express only keratin-8 (K8) and keratin-18 (K18), whereas cholangiocytes also express K19. In this study, we delineate the pattern of normal time-course changes in serum K19 and K18 levels after liver transplantation. Serum levels of the K19 fragment CYFRA 21-1 and the K18 fragments tissue polypeptide specific antigen (TPS) and M30 (a neoepitope that is generated after caspase cleavage during apoptosis) were measured at baseline and at regular intervals (up to 6 months) after liver transplantation in 11 adult patients.
There was a gradual decrease in serum K19 concentrations from baseline values after transplantation, following a time-course pattern similar to that of serum bilirubin. In contrast, serum concentrations of K18 fragments increased markedly shortly after transplantation and gradually decreased thereafter, following a time-course pattern similar to that of serum transaminases. The increase in TPS tended to occur earlier than that in M30, suggesting an initial predominance of hepatocyte necrosis followed by a predominance of apoptosis in the first days after transplantation. Five patients presented posttransplant complications (acute rejection in three cases and HCV recurrence in two cases). An early increase in serum K19 concentrations was observed in all cases. An increase in serum concentrations of K18 fragments (M30 and TPS) was observed in the two cases with HCV recurrence and was more variable in the three cases with acute rejection.
Serum concentrations of K19 and K18 fragments follow a dissimilar pattern of time-course changes after liver transplantation. The diagnostic value of variations in these normal patterns should be addressed in future studies.
在正常情况下，成年肝细胞仅表达角蛋白8（K8）和角蛋白18（K18），而胆管细胞还表达K19。在本研究中，我们描绘了肝移植后血清K19和K18水平正常的时间进程变化模式。在11例成年患者肝移植后的基线及定期（长达6个月）测量血清K19片段CYFRA 21 - 1、K18片段组织多肽特异性抗原（TPS）和M30（凋亡过程中半胱天冬酶切割后产生的新表位）的水平。
移植后血清K19浓度从基线值逐渐下降，其时间进程模式与血清胆红素相似。相比之下，K18片段的血清浓度在移植后不久显著增加，随后逐渐下降，其时间进程模式与血清转氨酶相似。TPS的增加往往比M30更早出现，表明移植后最初几天肝细胞坏死占主导，随后凋亡占主导。5例患者出现移植后并发症（3例急性排斥反应和2例丙型肝炎病毒复发）。所有病例均观察到血清K19浓度早期升高。2例丙型肝炎病毒复发患者观察到K18片段（M30和TPS）的血清浓度增加，3例急性排斥反应患者的变化更具变异性。
肝移植后血清K19和K18片段的浓度呈现不同的时间进程变化模式。这些正常模式变化的诊断价值应在未来研究中探讨。
