Zusammenfassung
Die Lebertransplantation ist eine etablierte Therapieoption zur Behandlung von Patienten mit einer irreversiblen Lebererkrankung im Endstadium. Das Therapiemanagement der Patienten erfolgt interdisziplinär und verlangt von den Pathologen Kenntnisse sowohl der Klinik wie auch der Immunologie. Stetige Fortschritte in der Behandlung und die zunehmende klinische Erfahrung gehen mit der Weiterentwicklung der pathologischen Transplantationsdiagnostik einher. Im vorliegenden Artikel werden die neueste Klassifikation der T‑Zell-mediierten Abstoßung (TCMR), der antikörpermediierten Abstoßung (AMR) sowie Aspekte der Prätransplantationsdiagnostik vorgestellt und diskutiert.
Abstract
Liver transplantation is an established treatment option for patients with end-stage liver disease. The therapy management of these patients is interdisciplinary and requires pathologists to have both clinical and immunological knowledge. Continuous advances in treatment and increasing clinical experience are accompanied by the further development of pathological transplant diagnostics. This article presents and discusses the latest classification of T‑cell-mediated rejection (TCMR), antibody-mediated rejection (AMR), and aspects of pretransplant diagnostics.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Andres GA, Ansell ID, Halgrimson CG et al (1972) Immunopathological studies of orthotopic human liver allografts. Lancet 1:275–280
Anonymous (1997) Banff schema for grading liver allograft rejection: an international consensus document. Hepatology 25:658–663
Bedossa P, Poitou C, Veyrie N et al (2012) Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology 56:1751–1759
Demetris AJ (1995) Terminology for hepatic allograft rejection. International Working Party. Hepatology 22:648–654
Demetris AJ, Seaberg EC, Batts KP et al (1998) Chronic liver allograft rejection: a National Institute of Diabetes and Digestive and Kidney Diseases interinstitutional study analyzing the reliability of current criteria and proposal of an expanded definition. National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. Am J Surg Pathol 22:28–39
Demetris AJ, Bellamy C, Hubscher SG et al (2016) 2016 comprehensive update of the Banff Working Group on Liver Allograft Pathology: introduction of antibody-mediated rejection. Am J Transplant 16:2816–2835
Drebber U, Torbenson M, Wedemeyer I et al (2011) Current aspects of liver allograft pathology. Pathologe 32:113–123
Durand F, Renz JF, Alkofer B et al (2008) Report of the Paris consensus meeting on expanded criteria donors in liver transplantation. Liver Transpl 14:1694–1707
Fiel MI, Agarwal K, Stanca C et al (2008) Posttransplant plasma cell hepatitis (de novo autoimmune hepatitis) is a variant of rejection and may lead to a negative outcome in patients with hepatitis C virus. Liver Transpl 14:861–871
Koo J, Wang HL (2018) Acute, chronic, and humoral rejection: pathologic features under current immunosuppressive regimes. Surg Pathol Clin 11:431–452
Nakamura K, Murase N, Becich MJ et al (1993) Liver allograft rejection in sensitized recipients. Observations in a clinically relevant small animal model. Am J Pathol 142:1383–1391
Nakanuma Y, Tsuneyama K, Harada K (2001) Pathology and pathogenesis of intrahepatic bile duct loss. J Hep Bil Pancr Surg 8:303–315
Nascimbeni F, Bedossa P, Fedchuk L et al (2020) Clinical validation of the FLIP algorithm and the SAF score in patients with non-alcoholic fatty liver disease. J Hepatol 72:828–838
Neil DA, Hubscher SG (2002) Histologic and biochemical changes during the evolution of chronic rejection of liver allografts. Hepatology 35:639–651
O’leary JG, Demetris AJ, Friedman LS et al (2014) The role of donor-specific HLA alloantibodies in liver transplantation. Am J Transplant 14:779–787
O’leary JG, Shiller MS, Bellamy C et al (2014) Acute liver allograft antibody-mediated rejection: an inter-institutional study of significant histopathological features. Liver Transpl 20:1244–1255
O’leary JG, Cai J, Freeman R et al (2016) Proposed diagnostic criteria for chronic antibody-mediated rejection in liver allografts. Am J Transplant 16:603–614
Reis H, Peterek PT, Wohlschlaeger J et al (2014) Oil Red O‑assessed macrosteatosis in liver transplant donor biopsies predicts ischemia-reperfusion injury and clinical outcome. Virchows Arch 464:165–174
Roeb E, Steffen HM, Bantel H et al (2015) S2k Guideline non-alcoholic fatty liver disease. Z Gastroenterol 53:668–723
Sanyal AJ, Brunt EM, Kleiner DE et al (2011) Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology 54:344–353
Schleicher C, Kreipe HH, Schemmer P et al (2019) Donor liver histology: joint recommendations of the DGP, DTG and DSO. Chirurg 90:899–904
Wang HL (2011) Rejection. In: Liapis H, Wang HL (Hrsg) Pathology of solid organ transplantation. Springer, Berlin, S 244–262
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
H. A. Baba, S. Theurer, A. Canbay, S. Schwertheim, E. Lainka, J. Kälsch und J. Wohlschläger geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
Schwerpunktherausgeber
T. Longerich, Heidelberg
H. A. Baba, Essen
Rights and permissions
About this article
Cite this article
Baba, H.A., Theurer, S., Canbay, A. et al. Lebertransplantation. Aktuelle Aspekte der Prätransplantationsdiagnostik und Abstoßung. Pathologe 41, 505–514 (2020). https://doi.org/10.1007/s00292-020-00813-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00292-020-00813-9