BIOCHEMICAL AND HISTOPATHOLOGICAL CORRELATION IN LIVER-TRANSPLANT - THE 1ST 180 DAYS

被引:56
作者
HENLEY, KS
LUCEY, MR
APPELMAN, HD
BALIGA, P
BROWN, KA
BURTCH, GD
CAMPBELL, DA
HAM, JM
MERION, RM
TURCOTTE, JG
机构
[1] UNIV MICHIGAN,SCH MED,DEPT PATHOL,ANN ARBOR,MI 48109
[2] UNIV MICHIGAN,SCH MED,DEPT SURG,ANN ARBOR,MI 48109
关键词
D O I
10.1002/hep.1840160312
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
It is not known whether the histopathology of the liver allograft can be predicted from biochemical measurements in serum with the same confidence as in the native liver. To answer this question we compared the histopathological diagnoses in 170 biopsy specimens from 70 adult transplant recipients obtained during the first 180 days, with the concentrations of the serum bilirubin and the activities of AST, ALT and alkaline phosphatase measured at the same time. The most frequent diagnosis was cholestasis (n = 45), which was mild, moderate or severe and which may have been complicated by rejection (n = 28) or ischemia (n = 14). Hepatitis (n = 14), ischemia with rejection (n = 6) and spotty focal necrosis (n = 6) were diagnosed less frequently. Fifteen biopsy specimens were reported as histopathologically normal. In general, biochemical measurements discriminated poorly between different histopathological diagnoses. The histopathologically normal liver often showed an abnormal pattern of enzymes and an increase in the serum bilirubin level. As a result histopathologically normal biopsy specimens were indistinguishable biochemically from those with hepatitis. When two pathological conditions were found to coexist (e.g., cholestasis with either rejection or ischemic necrosis, or ischemic necrosis with rejection), the effect on the serum biochemistry was usually not additive and in some instances returned the biochemical abnormalities toward normal. With the exception of the serum bilirubin level, which increased with the severity of uncomplicated cholestasis, we could not identify a specific pattern of biochemical changes corresponding to a given histopathological diagnosis. We suggest that until more specific noninvasive methods of monitoring the transplanted liver are developed protocol liver biopsies offer the best means of identifying significant pathological conditions in liver allografts.
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页码:688 / 693
页数:6
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