Allen K J, Rand E B, Hart J, Whitington P F
Department of Pediatrics, University of Chicago, Illinois 60637, USA.
Transplantation. 1998 Mar 15;65(5):692-8. doi: 10.1097/00007890-199803150-00016.
We have observed centrilobular necrosis (CLN) in several liver allograft biopsies in our pediatric liver transplant population. The aims of this study were to describe the associated pathologic and clinical features of post-orthotopic liver transplantation CLN and determine its prognostic implications.
CLN was identified and characterized in 44 allografts from 40 patients (17 males and 23 females) among our 443 pediatric recipients. Twenty episodes were associated with cellular rejection, either in the same biopsy (n=15) or within the week prior (n=5), and five were associated with ductopenic rejection. Twelve were associated with vascular thrombosis. No clear etiology was identified in seven episodes, but two also had cholangitis lenta. Of the remaining five biopsies, three showed only centrilobular dropout, suggesting a resolution of some previous insult. The outcome of 40 patients following an initial episode of CLN was poor, with graft failure in 33, chronic poor function in 2, and normal recovery in only 5 patients. The results of retransplantation for graft failure due to CLN were equally poor, with 14 deaths, 3 patients with ductopenic rejection, and only 5 with normal recovery. CLN recurred in four grafts. Overall patient outcome was very poor: 25 deaths; 3 ductopenic rejections; 2 chronic poorly functioning livers; and 10 patients alive and well.
We conclude that CLN in pediatric orthotopic liver transplantation recipients is associated with cellular rejection, ductopenic rejection, or acute vessel thrombosis in the majority cases. The prognostic implications of CLN are grave, with high rates of graft failure requiring retransplantation and death.
在我们儿科肝移植人群的多次肝移植活检中，我们观察到了小叶中心坏死（CLN）。本研究的目的是描述原位肝移植后CLN的相关病理和临床特征，并确定其预后意义。
在我们443例儿科受者中，从40例患者（17例男性和23例女性）的44例移植肝中识别并描述了CLN。20例与细胞排斥反应相关，要么在同一次活检中（n = 15），要么在之前一周内（n = 5），5例与胆管减少性排斥反应相关。12例与血管血栓形成相关。7例未明确病因，但其中2例也有慢性胆管炎。在其余5例活检中，3例仅显示小叶中心肝细胞缺失，提示之前的某种损伤已缓解。40例患者在首次出现CLN后的预后较差，33例移植肝失败，2例慢性肝功能不佳，仅5例恢复正常。因CLN导致移植肝失败而再次移植的结果同样不佳，14例死亡，3例出现胆管减少性排斥反应，仅5例恢复正常。4例移植肝中CLN复发。总体患者预后非常差：25例死亡；3例胆管减少性排斥反应；2例慢性肝功能不佳的肝脏；10例患者存活且情况良好。
我们得出结论，儿科原位肝移植受者中的CLN在大多数情况下与细胞排斥反应、胆管减少性排斥反应或急性血管血栓形成相关。CLN的预后意义严重，移植肝失败率高，需要再次移植和死亡。
