Abstract:

Objective To find the histopathological features of chronic rejection by analyzing the histological data of liver biopsies from patients after allograft liver transplantation. Methods Histopathological data of 16 patients were collected retrospectively，who underwent hepatic puncture biopsy due to chronic rejection between January 2015 to 2016 in pathology department of the Third Affiliated Hospital, Sun Yat-sen University. Pathological analysis was performed after HE staining and immunohistochemical staining. Results Data of 16 livetransplant patients was analyzed，including 14 male and 2 female patients ；The average age was 44.75±8.98 ；The diagnoses were hepatitis B virus-related cirrhosis in 3 patients，hepatic malignancy in 7 patients，chronic severe hepatitis B in 5 patient and alcoholic cirrhosis in 1 patient. The common pathological changes by chronic rejection include injury，reduction or disappearance of interlobular bile ducts，necrotic inflammation in central lobular，and inflammatory cells infiltration in the portal area. The less common pathological features include damage of interlobular artery，degeneration and necrosis of hepatic cells，cholestasis，hyperplasia of Kupffer cells，and proliferation of fibrous tissues in portal areas. Conclusion The damage and number decreases in interlobular bile ducts are common and important pathological characteristics of chronic rejection. The patterns of pathologic changes for chronic rejection were overlapped with other diseases after liver transplantation. Clinical，laboratory and imaging examinations should also be taken into consideration，when making a phathological diagnosis.

摘要：

目的 通过观察人类同种肝移植术后患者的肝穿刺活检组织学资料，总结并分析肝移植慢性 排斥反应（CR）组织病理学特点。方法 回顾性分析 2015 年 1 月-2016 年 12 月中山大学附属第三医院病 理科收治的 16 例因 CR 而进行肝穿刺活检的病理组织学资料。通过苏木素 - 伊红染色法和免疫组织化学染 色法对标本进行病理学分析。结果 共纳入 16 例肝移植术后发生 CR 患者的资料，男性 14 例，女性 2 例 ； 平均年龄（44.75±8.98）岁 ；原发病为乙型肝炎肝硬化 3 例，肝恶性肿瘤 7 例，慢性重型乙型肝炎 5 例， 酒精性肝硬化 1 例。肝移植慢性排斥反应常见病理改变包括小叶间胆管损伤、减少或消失，小叶中央坏死 性炎症 ；汇管区炎症细胞浸润。较少见的病理特征包括小叶间动脉损伤、肝细胞变性及坏死、淤胆、库普 弗细胞增生以及纤维组织增生等。结论 小叶间胆管损伤及数量减少是诊断 CR 常见且重要的病理特征 ； CR 与其他肝移植术后病变的病理形态有重叠，须紧密结合临床、实验室及影像学检查进行鉴别。