肝脏异体移植物原发性无功能,伴有原有的微泡性脂肪变性/泡沫变性和轻度大滴大泡性脂肪变性。

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Research Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI:10.14740/gr1687
Melissa E Limia, Xiu Li Liu, Jennifer Yu, Kathleen Byrnes
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引用次数: 0

摘要

已经证实,轻度以上的大液滴大泡性脂肪变性(LD-MAS)与移植物无功能的风险增加有关。相比之下,即使是严重的小液滴大泡性脂肪变性(SD-MAS)对预后的影响也较小。目前还不清楚弥漫性小泡脂肪变性的供肝是否会增加移植物功能障碍的风险。一名患有酒精性肝硬化的 56 岁男性在脑死亡后移植了来自一名 42 岁超重男性供体的肝脏。采集供体肝脏活检的冰冻切片显示,透明/泡沫状肝细胞弥漫性增大,轻度LD-MAS(约占组织总量的5-10%)。在移植第0时间进行的再灌注肝脏活检显示出血、肝细胞苍白和增大、轻度LD-MAS(约占组织总量的10%)和脂质沉着。移植肝失去功能,患者在首次移植 24 小时后再次接受移植。对失败的肝脏异体移植组织学检查显示出广泛的出血坏死、中性粒细胞炎症、弥漫性微囊性脂肪变性和大量细胞外脂肪滴(约占组织总量的20%)。该病例表明,需要采取预防措施,避免使用弥漫性严重微囊脂肪变性的肝脏。
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Primary Non-Function of Hepatic Allograft With Preexisting Microvesicular Steatosis/Foamy Degeneration and Mild Large-Droplet Macrovesicular Steatosis.

It has been established that more than mild large-droplet macrovesicular steatosis (LD-MAS) is associated with increased risk of graft non-function. In contrast, even severe small-droplet macrovesicular steatosis (SD-MAS) has been found to be less prognostically significant. It remains unclear if a donor liver with diffuse microvesicular steatosis is associated with an increased risk of graft dysfunction. A 56-year-old male with alcoholic cirrhosis was transplanted with a liver from a 42-year-old overweight male donor after brain death. The frozen section of the donor liver biopsy taken at harvest showed diffusely enlarged clear/foamy hepatocytes and mild LD-MAS (about 5-10% of total tissue). The reperfusion liver biopsy taken at time 0 of transplantation showed hemorrhage, pale and enlarged hepatocytes, and mild LD-MAS (about 10% of total tissue) with lipopeliosis. The graft became non-functional, and the patient was re-transplanted 24 h after the initial transplantation. Histologic examination of the failed liver allograft showed extensive hemorrhagic necrosis, neutrophilic inflammation, diffuse microvesicular steatosis, and large extracellular fat droplets (about 20% of total tissue). This case demonstrates that precautions are needed to avoid using livers with diffuse and severe microvesicular steatosis.

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Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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