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Transplantationspathologie der Leber

Histopathology in liver transplantation

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Zusammenfassung

Die histopathologische Diagnostik nimmt einen wichtigen Stellenwert für die Analyse von Komplikationen im Rahmen der allogenen Lebertransplantation (LTX) ein. Dazu gehören die Indikationsstellung zur, die Analyse der Spenderleber vor und die Kontrollbiopsien nach LTX. Frühe Komplikationen sind der Preservations-/Reperfusionsschaden, der in der Nullbiopsie und bis zum Ende des ersten Monats auftreten kann, sowie die hyperakute und akute zelluläre Abstoßung mit Hauptmanifestationszeit im ersten Monat. Chirurgische Komplikationen können Ursache morphologischer Veränderungen im Lebergewebe sein, wie vaskuläre und biliäre Komplikationen. Opportunistische Infektionen und die chronische Abstoßung sind häufig im Zeitraum der ersten 12 Monate nach LTX zu verzeichnen, in den Folgemonaten und -jahren sind Rezidive der Grunderkrankung typisch. Medikamentös-toxische Leberparenchymschäden durch immunsuppressive oder andere Medikamente kommen vor. Bei einem hohen Prozentsatz erwachsener Patienten ist nach 6 Monaten das Auftreten einer idiopathischen chronischen Hepatitis beschrieben. Histologisch schwierige Differenzialdiagnosen sind kombinierte Schädigungsbilder aus verschiedenen Komplikationen.

Abstract

Histopathology plays an important role in the diagnosis of graft complications following liver transplantation (LTX) and includes the diagnosis of underlying liver disease, assessment of the donor liver before LTX and control biopsies after LTX. Within the early period after LTX (time zero and first month) preservation/reperfusion injury, as well as hyperacute and acute rejection may occur. Surgical vascular or biliary complications can cause parenchymal morphological changes. Within 12 months following LTX, histological signs of opportunistic infections and chronic rejection are frequent findings and disease recurrence is typical beyond the first year. Drug toxicity in liver allograft recipients can be induced by immunosuppressive therapy or other drugs. A high percentage of adult patients reveal histological features of idiopathic chronic hepatitis 6 months after LTX. Histopathological differential diagnosis of the combined underlying causes or complications is often difficult.

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Drebber, U., Dienes, H. Transplantationspathologie der Leber. Pathologe 29, 84–92 (2008). https://doi.org/10.1007/s00292-007-0956-0

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