Lee R G, Nakamura K, Tsamandas A C, Abu-Elmagd K, Furukawa H, Hutson W R, Reyes J, Tabasco-Minguillan J S, Todo S, Demetris A J
Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Gastroenterology. 1996 Jun;110(6):1820-34. doi: 10.1053/gast.1996.v110.pm8964408.
BACKGROUND & AIMS: Intestinal transplantation is a developing therapeutic option for patients with irreversible intestinal failure or short bowel syndrome. The aim of this study was to delineate the histopathology of human intestinal allografts and to define the features of intestinal rejection.
The histological features of 3015 endoscopic biopsy specimens and 23 allograft specimens from 62 intestinal recipients were analyzed retrospectively and correlated with clinical findings.
Acute allograft rejection was characterized by a varying combination of crypt injury, mucosal infiltration primarily by mononuclear cells (including blastic lymphocytes), and increased crypt cell apoptosis (more than 2 per 10 crypts). It represented a patchy, often ileal-centered process that could progress to mucosal ulceration; later episodes (more than 100 days posttransplant) tended to show lesser cellular infiltration and greater apoptosis than earlier episodes. Correlation with clinical rejection was good (false-positive rate of 9%; false-negative rate of 26%). Two resected specimens showed obliterative arteriopathy indicative of chronic rejection. In other specimens, preservation injury, cytomegalovirus infection, post-transplant lymphoproliferative disorder, and nonspecific features of active or past mucosal injury could be recognized.
Mucosal biopsy specimens are a useful means of monitoring intestinal allografts. Based on features validated by clinical correlation, acute rejection can be identified reliably and can be differentiated from the other pathological processes affecting the intestinal allograft.
对于不可逆性肠衰竭或短肠综合征患者，肠道移植是一种不断发展的治疗选择。本研究的目的是描述人肠道同种异体移植物的组织病理学特征，并明确肠道排斥反应的特点。
回顾性分析了62例肠道移植受者的3015份内镜活检标本和23份同种异体移植标本的组织学特征，并与临床发现进行关联分析。
急性同种异体移植排斥反应的特征为隐窝损伤、主要由单核细胞（包括母细胞样淋巴细胞）引起的黏膜浸润以及隐窝细胞凋亡增加（每10个隐窝中超过2个）的不同组合。它表现为一种散在性、常以回肠为中心的过程，可进展为黏膜溃疡；后期发作（移植后超过100天）往往比早期发作显示出较少的细胞浸润和较多的凋亡。与临床排斥反应的相关性良好（假阳性率为9%；假阴性率为26%）。两份切除标本显示有闭塞性动脉病，提示慢性排斥反应。在其他标本中，可以识别出保存损伤、巨细胞病毒感染、移植后淋巴细胞增殖性疾病以及活动性或既往黏膜损伤的非特异性特征。
黏膜活检标本是监测肠道同种异体移植物的有用手段。基于经临床相关性验证的特征，可以可靠地识别急性排斥反应，并将其与影响肠道同种异体移植物的其他病理过程区分开来。
