供受体血型不合肝移植2例病理观察  

ABO-incompatible liver transplantation: a pathological analysis of 2 cases

作　　者：丁鑫[1] 郑智勇[1] 王晨[1] 曾玲[1] 江艺[2] 

机构地区：[1]福建医科大学福总临床学院,中国人民解放军南京军区福州总医院病理科,福建省福州市350025 [2]福建医科大学福总临床学院,中国人民解放军南京军区福州总医院肝胆外科,福建省福州市350025

出　　处：《世界华人消化杂志》2008年第18期2056-2060,共5页World Chinese Journal of Digestology

摘　　要：目的:观察供受体血型不合肝移植的病理学特点,探讨移植肝体液排异反应的诊断标准.方法:采用常规染色和免疫组化法,观察2例供受体血型不合肝移植的病理改变以及肝组织中各种免疫球蛋白和补体的沉积情况.结果:光镜下,2例移植肝肝细胞普遍水肿,少量点状坏死,汇管区淋巴、单核细胞浸润.免疫组化结果显示CD3和CD20阳性细胞混合,肝血窦内皮细胞上有不同程度IgG、IgM、IgA、C4c、C4d和C1q线状或颗粒状沉积.其中1例诊断为轻度急性细胞性排斥反应,伴轻度体液排斥反应;另外1例诊断为轻度器官保存/再灌注损伤,轻度体液排斥反应.结论:IgG等免疫球蛋白在肝窦内皮细胞上弥漫强阳性沉积,并伴有C4d等补体成分表达,可作为移植肝组织中存在体液排异反应的证据.AIM： To observe the pathological features of ABO-incompatible liver transplantation, and to investigate the diagnostic criteria for humoral rejection of liver transplantation. METHODS： The pathological changes and the deposition of all kinds of immunoglobulins and complements were observed in 2 cases of ABO- incompatible liver transplantation by immunohistochemical and HE staining. RESULTS： Under light microscope, hepatocyte edema, spotty necrosis, infiltration of lymphacytes and mononuclear cells in portal region were observed in the transplanted livers of both cases. Immunohistochemistry showed mixture of CD3-and CD20-positive cells and different degrees of linear or granular depositions of IgG, IgM, IgA, C4c, C4d and C1q in the liver sinusoidal endothelial cells. One of the cases was diagnosed with light acute cellular rejection accompanied by light humoral rejection, and the other was diagnosed with light liver preservation and reperfusion injury accompanied by light humoral rejection. CONCLUSION： It may be regard as the evidence of humoral rejection in hepatic tissues that immunoglobulin G accompanied with C4d and other complements diffusely deposits in hepatic sinusoidal endothelial cells.

关 键 词：肝移植 血型不合 体液排异反应 免疫组化 

分 类 号：R657.3[医药卫生—外科学]