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Aktuelle Aspekte zur Histopathologie im Rahmen der Lebertransplantation

Current aspects of liver allograft pathology

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Zusammenfassung

Die histopathologische Diagnostik der Leberbiopsie bildet einen wichtigen Grundstein der Diagnose und des Managements von Komplikationen im Verlauf der allogenen Lebertransplantation. In diesem Artikel werden histopathologische Schädigungsmuster unter Berücksichtigung neuer Aspekte aus der Literatur dargestellt. Innerhalb des Themengebiets der Transplantatabstoßung gilt der so genannten späten zellulären Abstoßung ein besonderes Interesse, wobei die histologischen Kriterien sich von der akuten zellulären Abstoßung unterscheiden und es eine Überlappung mit der De-novo-Autoimmunhepatitis und der idiopathischen Posttransplantationshepatitis zu geben scheint. Die zentrale Perivenulitis gilt als typisches Zeichen der späten zellulären Abstoßung und sollte differenzialdiagnostisch zu toxischen Zone-3-Nekrosen abgegrenzt werden. Neben der Abstoßungsproblematik ergeben sich vaskuläre und biliäre Veränderungen aus chirurgischen Komplikationen oder Folgen der immunsuppressiven Therapie. Des Weiteren spielt die Rekurrenz der zur Transplantation führenden Grunderkrankung eine wichtige Rolle. Insbesondere können auch kombinierte Schädigungsbilder vorkommen und stellen eine besondere Herausforderung an den Pathologen dar.

Abstract

Liver allograft pathology continues to play an important role in the diagnosis and management of complications in the course of liver transplantation. This article summarizes important patterns of liver damage and also considers new aspects of transplant pathology from the literature. In the context of transplant rejection, late cellular rejection has aroused new interest. Histopathological changes in late rejection differ from acute cellular rejection and there seem to be similarities to de novo autoimmune hepatitis and idiopathic post-transplant hepatitis. Central perivenulitis is a typical change in late cellular rejection and should be differentiated from central toxic necrosis. Other important areas of transplant pathology include vascular and biliary changes resulting from surgical complications or as sequelae of immunosuppressive therapy. Furthermore, disease recurrence plays an important role and combined patterns of disease poses a challenge for the pathologist.

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    U. Drebber, I. Wedemeyer & H.P. Dienes

  2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, USA

    M. Torbenson

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  1. U. Drebber
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  2. M. Torbenson
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  3. I. Wedemeyer
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  4. H.P. Dienes
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Correspondence to U. Drebber.

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Drebber, U., Torbenson, M., Wedemeyer, I. et al. Aktuelle Aspekte zur Histopathologie im Rahmen der Lebertransplantation. Pathologe 32, 113–123 (2011). https://doi.org/10.1007/s00292-010-1405-z

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