Neuberger J, Portmann B, Calne R, Williams R
Transplantation. 1984 Apr;37(4):363-5. doi: 10.1097/00007890-198404000-00009.
In a 26-year-old woman who had received an orthotopic liver graft for end-stage autoimmune chronic active hepatitis, signs indicative of the original disease became apparent 18 months after transplantation, at a time when the maintenance dose of prednisolone had been reduced to 3 mg daily. In addition to anorexia, nausea, and weight loss there was a reappearance of spider naevi, serum autoantibodies, and elevated levels of immunoglobulin G. Features typical of chronic active hepatitis were observed on examination of the liver biopsy, and both the clinical and histological pictures were unlike those of other possible causes of liver dysfunction, such as chronic rejection, cyclosporine hepatotoxicity, and non-A non-B chronic hepatitis. Following substitution of azathioprine for cyclosporine and an increased dose of prednisolone (20 mg daily), there was a rapid improvement in the clinical state and both serum transaminases and immunoglobulins returned to normal values. Histological appearances in a repeat biopsy taken six months later were consistent with chronic active hepatitis in remission. This case provides further evidence of the importance of host factors in the pathogenesis of chronic active hepatitis and emphasizes the necessity for selecting appropriate immunosuppressive therapy in such patients after transplantation.
一名26岁女性因终末期自身免疫性慢性活动性肝炎接受原位肝移植，移植18个月后，原疾病的体征变得明显，此时泼尼松龙维持剂量已减至每日3毫克。除厌食、恶心和体重减轻外，蜘蛛痣、血清自身抗体再次出现，免疫球蛋白G水平升高。肝活检检查发现了慢性活动性肝炎的典型特征，临床和组织学表现均不同于肝功能障碍的其他可能原因，如慢性排斥反应、环孢素肝毒性和非甲非乙型慢性肝炎。用硫唑嘌呤替代环孢素并增加泼尼松龙剂量（每日20毫克）后，临床状态迅速改善，血清转氨酶和免疫球蛋白均恢复至正常水平。6个月后重复活检的组织学表现与缓解期慢性活动性肝炎一致。该病例进一步证明了宿主因素在慢性活动性肝炎发病机制中的重要性，并强调了在此类患者移植后选择合适免疫抑制治疗的必要性。
