Izumi S, Nishiuchi M, Kameda Y, Nagano S, Fukunishi T, Kohro T, Shinji Y
Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan.
J Hepatol. 1994 Jan;20(1):129-37. doi: 10.1016/s0168-8278(05)80479-9.
Although peliosis hepatis and nodular transformation of the liver can occur after renal transplantation, their prevalence has not been well defined. To investigate the incidence of these complications, 137 laparoscopies were studied, 52 in 50 cases before and 85 in 66 cases after renal transplantation. To elucidate the aetiology and natural history of these diseases, cases were followed up by repeated laparoscopies. Peliosis was observed after transplantation (before: n = 1, after: n = 15 [22%], p < 0.005). Nodular transformation was seen only after transplantation (n = 5 [7%]), and was accompanied by peliosis (n = 4, p < 0.01). On observation before and after transplantation in the same cases, these diseases appeared after transplantation (peliosis: n = 9, p < 0.005; nodular transformation: n = 2). In follow-up cases, these diseases were confirmed after the discontinuation of or the controlled administration of immunosuppressants. The aetiology of the micronodular transformation which appeared following peliosis in a case treated without cyclosporin was shown to be azathioprine. However, the macronodular transformation observed in two cases treated with both azathioprine and cyclosporin seemed to be due to cyclosporin. This suggests that cases of peliosis hepatis and nodular transformation which appear after renal transplantation are associated with immunosuppressants, and that cyclosporin treatment may also affect the morphogenesis of nodular transformation.
虽然肝紫癜和肝脏结节样变可发生于肾移植术后，但其发生率尚未明确界定。为研究这些并发症的发生率，对137例腹腔镜检查进行了研究，其中肾移植术前50例中有52例，肾移植术后66例中有85例。为阐明这些疾病的病因及自然病程，通过重复腹腔镜检查对病例进行随访。移植后观察到了肝紫癜（术前：n = 1，术后：n = 15 [22%]，p < 0.005）。结节样变仅在移植后出现（n = 5 [7%]），且伴有肝紫癜（n = 4，p < 0.01）。在同一病例的移植前后观察中，这些疾病在移植后出现（肝紫癜：n = 9，p < 0.005；结节样变：n = 2）。在随访病例中，停用或控制使用免疫抑制剂后确诊了这些疾病。在一例未使用环孢素治疗的病例中，肝紫癜后出现的微结节样变的病因显示为硫唑嘌呤。然而，在两例同时使用硫唑嘌呤和环孢素治疗的病例中观察到的大结节样变似乎是由环孢素引起的。这表明肾移植后出现的肝紫癜和结节样变病例与免疫抑制剂有关，并且环孢素治疗可能也会影响结节样变的形态发生。
