Abstract:

 Objective The incidence，pathological changes and differential diagnosis of commoncomplications after liver transplantation have been studied，through a retrospective analysis of the pathological dataof 209 liver transplant biopsy tissues from a single center. Methods A total of 209 biopsies were performed in145 patients with liver transplantation from August 2013 to April 2023, at the Organ Transplantation Center of the First Hospital of Jilin University. The liver tissues were fixed with 4% neutral formaldehyde solution， embedded in paraffin and sectioned continuously， routinely HE staining， Masson， D-PAS， reticular fiber histochemical staining， CK7， CMV， C4dimmunohistochemical staining and EBER in situ hybridization were performed. Results Acute T cell-mediated rejection （TCMR） was the most common （36.84%） complication， followed by drug-induced liver injury（DILI）（23.44%） and biliary complications （14.35%）， others include Hepatitis B and Hepatitis C virus infection or recurrence，ischemia-reperfusion injury， cytomegalovirus infection， chronic rejection， plasma cell-rich rejection， vascular complications， recurrent primary disease， primary graft dysfunction， and difficult-to-diagnose liver morphology. The diagnosis of acute T cell-mediated rejection was based on portal inflammation， bile duct inflammation and venous endothelial inflammation. In 58.44% cases of TCMR， the classic“Triad” of portal area was found. In DILI， there were swelling or ballooning degeneration of hepatocytes around central vein， steatosis with different degrees， cholestasis in hepatocytes and bile canaliculi. Biliary complication was characterized by cholestasis in hepatocytes and bile canaliculi， proliferation of small bile ducts along the interface of the portal tract，and interstitial edema.Conclusion The pathological diagnosis should be made after comprehensive analysisof the clinical manifestation， laboratory examination， imaging data and medication history. 

Key words:

Liver transplantation, Needle biopsy, Pathology

摘要：

目的 通过对单中心 209 例次移植肝穿刺活检组织的病理资料回顾性分析，研究肝移植术后常见并发症的发生情况、病理学改变及鉴别诊断。方法 2013 年 8 月至 2023 年 4 月在吉林大学第一医院器官移植中心 145 例患者共行移植肝穿刺活检 209 次，采用快速石蜡包埋和制片技术流程，常规行 HE 染色、Masson、D-PAS 及网状纤维等组织化学染色和 CK7、CMV、C4d 等免疫组织化学染色，EBER 原位杂交检测EBV 感染。结果 急性 T 细胞介导的排斥反应最常见，占 36.84%，其次为药物性肝损伤，占 23.44%，第 3 位为胆管并发症，占 14.35%，此外还有乙型和丙型肝炎病毒感染或复发、缺血/再灌注损伤、巨细胞病毒感染、慢性排斥反应、富于浆细胞的排斥反应、血管并发症、原发病复发、移植肝原发无功能及难以诊断的肝形态。病理学改变 ：急性 T 细胞介导的排斥反应的诊断基于汇管区炎症、胆管上皮的炎性损害及静脉内皮炎，其中58.44% 的病例可见经典的汇管区“三联征”，药物性肝损伤最多见的病理改变为Ⅲ带为主的肝细胞变性、脂肪变性、肝细胞及毛细胆管内的胆汁淤积，胆管并发症表现为肝细胞和毛细胆管内胆汁淤积，汇管区内沿着界面分布的小胆管增生，增生胆管周围可见以中性粒细胞为主的炎细胞浸润，间质水肿。结论 病理医师需要结合患者的临床表现、实验室检查、影像学资料、用药史等资料综合分析并与临床医师充分沟通讨论后作出病理诊断。 

关键词:

肝移植 , 穿刺活检组织 , 病理学