Gómez R, Colina F, Moreno E, González I, Loinaz C, Garcia I, Musella M, Garcia H, Lumbreras C, Maffettone V
Department of General and Digestive Surgery, University Hospital, 12 de Octubre, Madrid, Spain.
J Hepatol. 1994 Sep;21(3):441-6. doi: 10.1016/s0168-8278(05)80325-3.
The incidence, contributing etiopathogenetic factors, and prognostic significance of centrilobular necrosis were investigated in 270 hepatic transplants to 215 immunosuppressed patients in whom 837 biopsies were performed. Twenty-six (9.6%) grafts demonstrated centrilobular necrosis in one or more biopsy specimens. The immunological, clinical, histopathological, and evolutionary features of this patient group (group A) were compared with a control group of patients who had undergone 92 consecutive transplants with no necrosis (group B). Group A was younger (p < 0.01), had a higher average of warm and cold-ischemia time (p < 0.05), a higher incidence (p < 0.001) and earlier appearance of acute rejection episodes (p < 0.01), and a closer association with evolution to chronic rejection (A: 53.8% vs B: 13.1%, p < 0.001). Survival rates for grafts and patients with necrosis at 12 and 30 months were significantly lower (p < 0.001). The 26 grafts were distributed into three chronological subgroups according to when necrosis appeared: (1) First week--All these grafts were lost (four through primary graft nonfunction and one due to protal recurrent thrombosis); (2) Second week--seven grafts with associated acute rejection, with three evolving to chronic rejection; (3) After the second week (116 +/- 82 days)--five with isolated necrosis, two with associated acute rejection, four with associated ductopenia, and three with associated acute rejection and ductopenia. In 11 grafts the necrosis persisted and evolved to chronic rejection. In conclusion, these findings indicate that centrilobular necrosis is a histopathological sign associated with poor prognosis in most hepatic grafts.(ABSTRACT TRUNCATED AT 250 WORDS)
对215例接受免疫抑制治疗的患者进行了270例肝移植，并对其进行了837次活检，以研究小叶中心坏死的发生率、相关病因及预后意义。26例（9.6%）移植肝在一次或多次活检标本中出现小叶中心坏死。将该患者组（A组）的免疫、临床、组织病理学及演变特征与连续92例未发生坏死的移植患者对照组（B组）进行比较。A组患者较年轻（p<0.01），平均热缺血和冷缺血时间较长（p<0.05），急性排斥反应发生率较高（p<0.001）且出现较早（p<0.01），与慢性排斥反应的演变关系更密切（A组：53.8% vs B组：13.1%，p<0.001）。坏死移植肝和患者在12个月及30个月时的生存率显著较低（p<0.001）。根据坏死出现的时间，将26例移植肝分为三个时间亚组：（1）第一周——所有这些移植肝均丢失（4例因原发性移植肝功能衰竭，1例因门静脉反复血栓形成）；（2）第二周——7例伴有急性排斥反应，3例演变为慢性排斥反应；（3）第二周后（116±82天）——5例为孤立性坏死，2例伴有急性排斥反应，4例伴有胆管减少，3例伴有急性排斥反应和胆管减少。11例移植肝中的坏死持续存在并演变为慢性排斥反应。总之，这些发现表明小叶中心坏死是大多数肝移植预后不良的组织病理学标志。（摘要截取自250字）
