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移植小肠病理学诊断标准及其进展

郭晖, 陈知水. 移植小肠病理学诊断标准及其进展[J]. 器官移植, 2022, 13(3): 307-316. doi: 10.3969/j.issn.1674-7445.2022.03.005
引用本文: 郭晖, 陈知水. 移植小肠病理学诊断标准及其进展[J]. 器官移植, 2022, 13(3): 307-316. doi: 10.3969/j.issn.1674-7445.2022.03.005
Guo Hui, Chen Zhishui. Diagnostic criteria and its progress on intestinal graft pathology[J]. ORGAN TRANSPLANTATION, 2022, 13(3): 307-316. doi: 10.3969/j.issn.1674-7445.2022.03.005
Citation: Guo Hui, Chen Zhishui. Diagnostic criteria and its progress on intestinal graft pathology[J]. ORGAN TRANSPLANTATION, 2022, 13(3): 307-316. doi: 10.3969/j.issn.1674-7445.2022.03.005

移植小肠病理学诊断标准及其进展

doi: 10.3969/j.issn.1674-7445.2022.03.005
基金项目: 

中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助 2019PT320014

详细信息
    作者简介:
    通讯作者:

    陈知水, Email: zschen@tjh.tjmu.edu.cn

  • 中图分类号: R617, R574.5

Diagnostic criteria and its progress on intestinal graft pathology

More Information
  • 摘要: 小肠移植已经成为肠衰竭最为理想的治疗方式。现代临床小肠移植包括3种类型:单独小肠移植、肝小肠联合移植和腹腔多器官簇移植。移植小肠具有与其它实体移植器官显著不同的免疫学和解剖生理学特点,导致移植小肠出现显著的急性排斥反应、慢性排斥反应、移植物抗宿主病(GVHD)、感染和移植后淋巴组织增生性疾病(PTLD)等诸多独特且严重的并发症,其中以急性排斥反应和感染尤为棘手。通过对移植小肠的内窥镜观察及肠黏膜活组织检查可以对上述并发症及时予以诊断和鉴别,进而予以针对性的治疗,更好地保障移植受者和移植小肠的长期存活。

     

  • 图  1  移植小肠急性排斥反应的内窥镜检查表现

    注:A~D图示移植小肠造口内窥镜检查见移植小肠肠壁黏膜水肿,黏膜表面糜烂以及可见直径0.3~0.6 cm的椭圆形或与黏膜皱襞平行的线型浅溃疡;E~F图示经治疗数日后再次内窥镜观察可见移植小肠充血水肿明显减轻,糜烂消失,溃疡明显愈合。

    Figure  1.  Endoscopic findings of acute rejection in intestinal graft

    图  2  移植小肠可疑的急性排斥反应的病理学表现

    注:A图示移植小肠黏膜活检组织内的黏膜上皮层完整,黏膜固有层内腺体排列规则,固有层仅轻度水肿、间质内少量的炎症细胞浸润(HE,×100);B图示隐窝上皮内偶见凋亡小体(箭头所示)(HE,×200)。

    Figure  2.  Pathological findings of suspected acute rejection in intestinal graft

    图  3  移植小肠轻度急性排斥反应的病理学表现

    注:A图示低倍镜下观,移植小肠黏膜完整,固有层内腺体排列规则,但固有层轻度水肿,有轻至中等量的单个核炎症细胞浸润(HE,×100);B图示中倍镜下观,黏膜固有层内腺体依然完整且排列规则,固有层内有单个核炎症细胞浸润(HE,×200);C图示高倍镜下观,隐窝上皮凋亡细胞数量增加(箭头所示)(HE,×400)。

    Figure  3.  Pathological findings of mild acute rejection in intestinal graft

    图  4  移植小肠中度急性排斥反应的病理学表现

    注:A图示移植小肠黏膜活检组织的低倍镜下观,可见黏膜固有层内大量密集的单个核炎症细胞浸润,局部黏膜上皮脱落呈糜烂(HE,×100);B图示移植小肠黏膜固有层内固有腺体明显减少,腺体排列紊乱,隐窝内凋亡细胞数量明显增加,黏膜固有层及黏膜下层等间质内大量的炎症细胞浸润(HE,×400)。

    Figure  4.  Pathological findings of moderate acute rejection in intestinal graft

    图  5  移植小肠的重度急性排斥反应的病理学表现

    注:A图示移植小肠黏膜活检组织低倍镜下观,可见黏膜皱襞消失,黏膜上皮细胞坏死脱落呈糜烂,表面附炎性渗出物和坏死组织,固有腺体减少或完全消失,炎症累及黏膜下层(HE,×100);B图示移植小肠重度急性排斥反应的高倍镜下观,可见固有腺体上皮层凋亡细胞数量明显增加,间质内混合有多数中性粒细胞的、显著的炎症细胞浸润(HE,×400)。

    Figure  5.  Pathological findings of severe acute rejection in intestinal graft

    图  6  移植小肠IRI的病理学表现

    注:图示移植小肠黏膜活检组织内小肠绒毛轻微水肿及少数黏膜上皮脱落(HE,×200)。

    Figure  6.  Pathological findings of IRI in intestinal graft

    图  7  移植小肠黏膜活检组织CMV阳性的病理学表现

    注:图示移植小肠黏膜活检组织内,小肠黏膜上皮细胞胞核及胞浆呈CMV阳性(免疫组化,×1 000)。

    Figure  7.  Pathological findings of CMV positive in biopsy tissue of mucosa of intestinal graft

    图  8  小肠移植后受者皮肤出现GVHD改变

    注:A图示皮肤活检组织内鳞状上皮基底部位以及真皮内淋巴细胞浸润(箭头所示)(HE,×400);B图示皮肤活检组织内鳞状上皮基底细胞凋亡(箭头所示)(HE,×400)。

    Figure  8.  GVHD changes in skin of recipient after intestinal transplantation

  • [1] VENICK RS. Current review on the role of ileostomy following intestinal transplantation[J]. Curr Opin Organ Transplant, 2022, 27(2): 126-130. DOI: 10.1097/MOT.0000000000000966.
    [2] MIZUSHIMA T, UDAGAWA E, HASEGAWA M, et al. Etiologies and treatments of chronic intestinal failure-short bowel syndrome (SBS) in Japanese adults: a real-world observational study[J]. Surg Today, 2022, DOI: 10.1007/s00595-022-02469-9[Epub ahead of print].
    [3] MCCALLUM Z, DELANY C, GILLAM L. Crossing the line? ethics of parenteral nutrition in paediatric neurodisability complicated by intestinal failure[J]. Arch Dis Child, 2022, DOI: 10.1136/archdischild-2021-323500[Epub ahead of print].
    [4] MEROLA J, SHAMIM A, WEINER J. Update on immunosuppressive strategies in intestinal transplantation[J]. Curr Opin Organ Transplant, 2022, 27(2): 119-125. DOI: 10.1097/MOT.0000000000000958.
    [5] FORTUNATO AC, PINHEIRO RS, MATSUMOTO CS, et al. Techniques for closing the abdominal wall in intestinal and multivisceral transplantation: a systematic review[J]. Ann Transplant, 2022, 27: e934595. DOI: 10.12659/AOT.934595.
    [6] LERUT JP, GONDOLESI GE. Immunosuppression in liver and intestinal transplantation[J]. Best Pract Res Clin Gastroenterol, 2021, 54/55: 101767. DOI: 10.1016/j.bpg.2021.101767.
    [7] WICHMANN D, NADALIN S, SCHWEIZER U, et al. Evaluating the diagnostic value of zoom endoscopic surveillance compared to routine biopsy after intestinal transplantation[J]. Dig Liver Dis, 2022, 54(3): 385-390. DOI: 10.1016/j.dld.2021.12.019.
    [8] DUCLAUX-LORAS R, BERTHILLER J, FERRONI A, et al. Clostridium difficile: a frequent infection in children after intestinal transplantation[J]. Transplantation, 2020, 104(1): 197-200. DOI: 10.1097/TP.0000000000002795.
    [9] SUDAN DL, KAUFMAN S, HORSLEN S, et al. Incidence, timing, and histologic grade of acute rejection in small bowel transplant recipients[J]. Transplant Proc, 2000, 32(6): 1199. DOI: 10.1016/s0041-1345(00)01182-9.
    [10] 李元新, 黎介寿, 李宁, 等. 人体小肠移植的内窥镜监测[J]. 中华器官移植杂志, 1997, 18(4): 229-230. DOI: 10.3760/cma.j.issn.0254-1785.1997.04.019.

    LI YX, LI JT, LI N, et al. Endoscopic observation of human small intestinal transplantation[J]. Chin J Organ Transplant, 1997, 18(4): 229-230. DOI: 10.3760/cma.j.issn.0254-1785.1997.04.019.
    [11] 郭晖. 小肠移植排斥反应病理学[M]//陈实. 移植免疫学. 武汉: 湖北科技出版社, 1998: 235-237.
    [12] MOON JI, SCHIANO TD, IYER KR. Routine surveillance endoscopy and biopsy after isolated intestinal transplantation-revisiting the gold standard[J]. Clin Transplant, 2019, 33(10): e13684. DOI: 10.1111/ctr.13684.
    [13] JELLY ET, KWUN J, SCHMITZ R, et al. Optical coherence tomography of small intestine allograft biopsies using a handheld surgical probe[J]. J Biomed Opt, 2021, 26(9): 096008. DOI: 10.1117/1.JBO.26.9.096008.
    [14] CRISMALE JF, MAHMOUD D, MOON J, et al. The role of endoscopy in the small intestinal transplant recipient: a review[J]. Am J Transplant, 2021, 21(5): 1705-1712. DOI: 10.1111/ajt.16354.
    [15] KÖNIGSRAINER A, LADURNER R, IANNETTI C, et al. The 'blind innsbruck ostomy', a cutaneous enterostomy for long-term histologic surveillance after small bowel transplantation[J]. Transpl Int, 2007, 20(10): 867-874. DOI: 10.1111/j.1432-2277.2007.00541.x.
    [16] GULLEROGLU K, BASKIN E, OZDEMIR H, et al. Clinical impact of complement deposition findings on biopsies in acute rejection episodes of pediatric renal transplant patients[J]. Transpl Immunol, 2021, 69: 101466. DOI: 10.1016/j.trim.2021.101466.
    [17] FUJINO T, KUMAI Y, YANG B, et al. Discordance between immunofluorescence and immunohistochemistry C4d staining and outcomes following heart transplantation[J]. Clin Transplant, 2021, 35(4): e14242. DOI: 10.1111/ctr.14242.
    [18] ŁABUŚ A, MUCHA K, KULESZA A, et al. Costs of treatment of acute antibody-mediated rejection in kidney transplant recipients[J]. Transplant Proc, 2022, DOI: 10.1016/j.transproceed.2021.11.039[Epub ahead of print].
    [19] LOUIS K, MACEDO C, LEFAUCHEUR C, et al. Adaptive immune cell responses as therapeutic targets in antibody-mediated organ rejection[J]. Trends Mol Med, 2022, 28(3): 237-250. DOI: 10.1016/j.molmed.2022.01.002.
    [20] WU GS, CRUZ RJ JR, CAI JC. Acute antibody-mediated rejection after intestinal transplantation[J]. World J Transplant, 2016, 6(4): 719-728. DOI: 10.5500/wjt.v6.i4.719.
    [21] STOBUTZKI N, SCHLICKEISER S, STREITZ M, et al. Long-term signs of T cell and myeloid cell activation after intestinal transplantation with cellular rejections contributing to further increase of CD16+ cell subsets[J]. Front Immunol, 2019, 10: 866. DOI: 10.3389/fimmu.2019.00866.
    [22] SPAGGIARI M, LICHVAR A, TZVETANOV I, et al. Temporary deceased donor splenic transplant prior to intestinal transplantation: a new strategy for desensitization?[J]. Transplant Proc, 2021, 53(8): 2602-2608. DOI: 10.1016/j.transproceed.2021.08.008.
    [23] MATSUMOTO CS, ROSEN-BRONSON S. Donor-specific antibody and sensitized patients in intestinal transplantation[J]. Curr Opin Organ Transplant, 2021, 26(2): 245-249. DOI: 10.1097/MOT.0000000000000853.
    [24] GAITONDE S, HASSAN M, MEHTA V, et al. Histopathology of human donor spleen utilized as a desensitization tool before intestinal transplantation[J]. Am J Clin Pathol, 2021, 155(5): 621-626. DOI: 10.1093/ajcp/aqaa175.
    [25] CORREA-MARTÍNEZ CL, BECKER F, SCHWIERZECK V, et al. Donor-derived vancomycin-resistant enterococci transmission and bloodstream infection after intestinal transplantation[J]. Antimicrob Resist Infect Control, 2020, 9(1): 180. DOI: 10.1186/s13756-020-00845-z.
    [26] ÅBERG F, SAVIKKO J, ANTTILA VJ, et al. Severe allograft rejection in an intestinal transplant patient following oral immunoglobulin treatment for chronic norovirus infection: a case report[J]. Clin Case Rep, 2018, 6(7): 1232-1235. DOI: 10.1002/ccr3.1493.
    [27] STANLEY K, RANGANATHAN S, MAZARIEGOS G, et al. Donor mucosal immunocytes perpetuate refractory GVHD after intestinal transplantation without engrafting in recipient bone marrow: case report and review of the literature[J]. Pediatr Transplant, 2019, 23(2): e13350. DOI: 10.1111/petr.13350.
    [28] GERLACH UA, MORLAND B, HOBIN D, et al. Atypical malignancies after intestinal transplantation in children: a European single-centre experience[J]. Pediatr Transplant, 2020, 24(3): e13697. DOI: 10.1111/petr.13697.
    [29] KAUFMAN SS, HUSSAN E, KROEMER A, et al. Graft versus host disease after intestinal transplantation: a single-center experience[J]. Transplant Direct, 2021, 7(8): e731. DOI: 10.1097/TXD.0000000000001187.
    [30] GANOZA A, MAZARIEGOS GV, KHANNA A. Current status of graft-versus-host disease after intestinal transplantation[J]. Curr Opin Organ Transplant, 2019, 24(2): 199-206. DOI: 10.1097/MOT.0000000000000624.
    [31] OLTEAN M. Intestinal transplantation: an overview of the recent experimental studies[J]. Curr Opin Organ Transplant, 2021, 26(2): 240-244. DOI: 10.1097/MOT.0000000000000845.
    [32] DEVINE K, RANGANATHAN S, MAZARIEGOS G, et al. Induction regimens and post-transplantation lymphoproliferative disorder after pediatric intestinal transplantation: single-center experience[J]. Pediatr Transplant, 2020, 24(5): e13723. DOI: 10.1111/petr.13723.
    [33] CHIOU FK, BEATH SV, MORLAND B, et al. Comparison of clinical features and outcome of pediatric posttransplant lymphoproliferative disorder in recipients of small bowel allograft versus isolated liver transplantation[J]. Transplantation, 2020, 104(7): 1429-1436. DOI: 10.1097/TP.0000000000003004.
    [34] ANDRES AM, RAMOS E, HERNANDEZ F. Current status of pediatric intestinal transplant in Europe[J]. Curr Opin Organ Transplant, 2020, 25(2): 183-188. DOI: 10.1097/MOT.0000000000000736.
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出版历程
  • 收稿日期:  2022-03-21
  • 网络出版日期:  2022-04-29
  • 刊出日期:  2022-05-15

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