Chen C H, Chen P J, Chu J S, Yeh K H, Lai M Y, Chen D S
Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, Taipei.
Gastroenterology. 1994 Nov;107(5):1514-8. doi: 10.1016/0016-5085(94)90557-6.
A 45-year-old hepatitis B surface antigen carrier had an allograft kidney transplantation and maintenance immunosuppression with cyclosporin A and prednisolone. Six months later, she experienced a rapidly progressive hepatic failure manifested by elevation of serum bilirubin level, prolongation of prothrombin time, and mild to modest increase of serum aminotransferase levels. She died in 6 weeks. Postmortem liver histology showed canalicular and cellular cholestasis and ground-glass appearance and ballooning of most hepatocytes, but only mild inflammatory cell infiltration. Immunohistochemical staining showed massive loads of hepatitis B surface and core antigens in the hepatocytes and extensive periportal fibrosis. The whole picture was compatible with fibrosing cholestatic hepatitis described in hepatitis B virus-infected liver transplant. Sequencing of the hepatitis B virus genome amplified from the patient's serum indicated a precore mutant but few mutations in the core, pre-S, and S genes. Little inflammatory reaction was observed histologically despite HLA compatibility, a situation differing from that in liver transplant. This observation indicates that fibrosing cholestatic hepatitis may also occur in non-liver transplant setting.
一名45岁的乙肝表面抗原携带者接受了同种异体肾移植，并使用环孢素A和泼尼松龙进行维持性免疫抑制治疗。6个月后，她出现了快速进展的肝衰竭，表现为血清胆红素水平升高、凝血酶原时间延长以及血清转氨酶水平轻度至中度升高。她在6周后死亡。尸检肝脏组织学检查显示胆小管和细胞性胆汁淤积、毛玻璃样外观以及大多数肝细胞气球样变，但仅有轻度炎症细胞浸润。免疫组织化学染色显示肝细胞内大量乙肝表面抗原和核心抗原以及广泛的汇管区周围纤维化。整体情况与乙肝病毒感染的肝移植中描述的纤维性胆汁淤积性肝炎相符。从患者血清中扩增的乙肝病毒基因组测序显示为前C区突变，但核心区、前S区和S区基因的突变很少。尽管HLA配型相符，但组织学上观察到的炎症反应很少，这种情况与肝移植不同。这一观察结果表明，纤维性胆汁淤积性肝炎也可能发生在非肝移植情况下。
