Lautenschlager I, Nashan B, Schlitt H J, Hoshino K, Ringe B, Tillmann H L, Manns M, Wonigeit K, Pichlmayr R
Clinic of Abdominal and Transplantation Surgery, Medical School Hannover, Germany.
Transplantation. 1994 Dec 27;58(12):1339-45.
Fine-needle aspiration biopsy (FNAB) is a routine diagnostic tool used for the monitoring of the graft during the first postoperative weeks after liver transplantation. The cellular pattern of acute liver rejection is typical in transplant aspiration cytology (TAC), documented and published by several authors. The lymphoid response associated with various viral infections may, however, provide differential diagnostic problems in the cytological monitoring. In this study, we have investigated in detail the cellular pattern of lymphoid response associated with hepatitis C virus (HCV) reactivation, and compared it with the pattern of cytomegalovirus (CMV) infection and with the typical diagnostic findings of acute cellular rejection. HCV reactivation was associated with rather mild total inflammation in the graft (4.5 +/- 1.5 CIU at the peak). The inflammatory infiltrate consisted mainly of small lymphocytes (3.1 +/- 0.2 CIU at the peak), with only occasional activated cells and without lymphoid blast response. No lymphoid activation was seen in the blood. CMV infection was associated with a mild immune response (3.9 +/- 0.4 CIU at the peak) recorded as a slight lymphoid activation and occasional blast cells both in blood and in the graft together with lymphocytosis in the graft (2.4 +/- 0.7 CIU at the peak). The typical findings of acute rejection were easily distinguished from the cellular pictures of both viral infections. The rejections were lymphoid blast (3.6 +/- 3.4 CIU at the peak) and activated lymphocyte (3.5 +/- 2.6 at the peak), dominated by a high peak of total inflammation (9.3 +/- 7.0 CIU). No blast cells and only a few activated cells were seen in the blood during rejection episodes. Thus, the cellular patterns of HCV reactivation and CMV infection differed slightly from each other, but significantly from that of acute liver allograft rejection monitored with the FNAB cytology.
细针穿刺活检（FNAB）是一种常规诊断工具，用于在肝移植术后的最初几周内监测移植物。急性肝排斥反应的细胞模式在移植穿刺细胞学（TAC）中很典型，已有多位作者进行了记录和发表。然而，与各种病毒感染相关的淋巴细胞反应可能会在细胞学监测中带来鉴别诊断问题。在本研究中，我们详细调查了与丙型肝炎病毒（HCV）再激活相关的淋巴细胞反应的细胞模式，并将其与巨细胞病毒（CMV）感染的模式以及急性细胞排斥反应的典型诊断结果进行了比较。HCV再激活与移植物中相当轻微的总体炎症相关（峰值时为4.5±1.5 CIU）。炎症浸润主要由小淋巴细胞组成（峰值时为3.1±0.2 CIU），仅有偶尔的活化细胞，且无淋巴细胞母细胞反应。血液中未见淋巴细胞活化。CMV感染与轻微的免疫反应相关（峰值时为3.9±0.4 CIU），表现为血液和移植物中轻微的淋巴细胞活化和偶尔的母细胞，同时移植物中有淋巴细胞增多（峰值时为2.4±0.7 CIU）。急性排斥反应的典型表现很容易与两种病毒感染的细胞图像区分开来。排斥反应表现为淋巴细胞母细胞（峰值时为3.6±3.4 CIU）和活化淋巴细胞（峰值时为3.5±2.6），以总体炎症的高峰（9.3±7.0 CIU）为主。在排斥反应发作期间，血液中未见母细胞，仅有少数活化细胞。因此，HCV再激活和CMV感染的细胞模式彼此略有不同，但与通过FNAB细胞学监测的急性肝同种异体移植排斥反应的模式有显著差异。
