DOI: http://dx.doi.org/10.22516/25007440.104

Patología del trasplante hepático, aspectos más relevantes del período postrasplante tardío

Rocio del Pilar López Panqueva

Resumen


La sobrevida de los pacientes postrasplante hepático supera el 90% al año y el 75% a los 5 años. Entender las causas de pérdida del injerto, o inclusive la muerte del paciente, es esencial para mejorar aún más los resultados a largo plazo. La evaluación de las biopsias hepáticas tiene un papel importante en la explica- ción y manejo de la disfunción del injerto de hígado, que ocurre después del primer año del trasplante. La interpretación de estas biopsias puede ser muy difícil, en especial por la alta incidencia de enfermedades recurrentes que pueden mostrar un cuadro clínico y unas características histopatológicas que semejan varias condiciones, especialmente cuando el rechazo agudo o crónico pueden sobreponerse a una patología ya existente o presentarse de manera simultánea y contribuir a la disfunción tardía del injerto, por lo que el análisis de la biopsia puede ayudar a determinar el componente principal de la lesión. Es indispensable la correlación clínico patológica, teniendo en cuenta la enfermedad original, el tipo de inmunosupresión, las pruebas de función hepática, las serologías virales, los autoanticuerpos y los hallazgos radiológicos. En este artículo comentaré las patologías más frecuentes y las que causan más problemas en su diagnóstico durante el período postrasplante tardío. 


Palabras clave


Biopsia hepática; postrasplante hepático; rechazo crónico; ductopenia; hepatitis viral C recurrente; hepatitis autoimmune recurrente; hepatitis autoimmune de novo; cirrhosis biliar primaria recurrente; colangitis esclerosante primaria recurrente

Texto completo:

PDF PDF (English)

Referencias


Banff Working Group, Demetris AJ et al. Liver biopsy interpretation for causes of late liver allograft dysfunction. Hepatology. 2006;44(2):489-501.

Petrovic LM. Recurrent diseases following liver transplantation: Current concepts. Curr Opin Organ Transplant. 2012;17(3):293-302.

Berenguer M, Aguilera V, Prieto M, Carrasco D, Rayón M, San Juan F, Landaverde C, Mir J, Berenguer J. Delayed onset of severe hepatitis C-related liver damage following liver transplantation: a matter of concern? Liver Transpl. 2003;9(11):1152-1158.

Mylene Sebagh, Kinan Rifai, Cyrille Feray, Funda Yilmaz, Bruno Falissard, Bruno Roche, Henri Bismuth, Didier Samuel, and Michel Reynes All Liver Recipients Benefit From the Protocol 10-Year Liver Biopsies Hepatology. 2003;37(6):1293-1301.

Kim H, Lee KW, et al. Response-Guided Therapy for Hepatitis C Virus Recurrence Based on Early Protocol Biopsy after Liver Transplantation. J Korean Med Sci. 2015;30(11):1577-83.

Gutiérrez JA, Carrión AF, Avalos D, O’Brien C, Martin P, Bhamidimarri KR, Peyton A. Sofosbuvir and simeprevir for treatment of hepatitis C virus infection in liver transplant recipients. Liver Transpl. 2015;21(6):823-30.

Adeyi O, Fischer SE, Guindi M. Liver allograft pathology: approach to interpretation of needle biopsies with clinicopathological correlation. J Clin Pathol. 2010;63(1):47-74.

Kanodia KV, Vanikar AV, Modi PR, Patel RD, Suthar KS, Nigam LK, Trivedi HL Histological and Clinicopathological Evaluation of Liver Allograft Biopsy: An Initial Experience of Fifty Six Biopsies. J Clin Diagn Res. 2015;9(11):EC17-20.

Mylene Sebagh, Karin Blakolmer, Bruno Falissard, Bruno Roche, Jean-Francois Emile, Henri Bismuth, Didier Samuel, and Michel Reynes. Accuracy of Bile Duct Changes for the Diagnosis of Chronic Liver Allograft Rejection: Reliability of the 1999 Banff Schema. Hepatology. 2002;35(1):117-125.

Inomata Y, Tanaka K. Pathogenesis and treatment of bile duct loss after liver transplantation. J Hepatobiliary Pancreat Surg. 2001;8(4):316-22.

Nakanuma Y, Tsuneyama K, Harada K. Pathology and pathogenesis of intrahepatic bile duct loss. J Hepatobiliary Pancreat Surg. 2001;8(4):303-15.

Demetris A et al. Update of the International Banff Schema for Liver Allograft Rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. An International Panel. Hepatology. 2000;31(3):792-9.

Kim WR, Stock PG, Smith JM, et al. OPTN/SRTR 2011 Annual Data Report liver. Am Transplant. 2013;13(suppl 1):73-102.

García-Retortillo M, Forns X, Feliu A, et al. Hepatitis C virus kinetics during and immediately after liver transplantation. Hepatology 2002;35(3):680-7.

Pelletier SJ, Schaubel DE, Punch JD, Wolfe RA, Port FK, Merion RM. Hepatitis C is a risk factor for death after liver retransplantation. Liver Transpl. 2005;11(4):434-440.

Vasuri F, Malvi D, Gruppioni E,Grigioni WF, D’Errico- Grigioni A. Histopathological evaluation of recurrent hepatitis C after liver transplantation: a review. World J Gastroenterol. 2014;20(11):2810-24.

Berenguer M, López-Labrador FX, Wright TL. Hepatitis C and liver transplantation. J Hepatol. 2001;35:666-678.

Gambato M, Crespo G, Torres F, Llovet L, Carrión J, Londoño M, Lens S, Mariño Z, Bartres C, Miquel R, Navasa M, Forns X Simple prediction of long-term clinical outcomes in patients with mild hepatitis C recurrence after liver transplantation. Transpl Int. 2016;29(6):698-706.

Carmen Vinaixa, Ángel Rubín, Victoria Aguilera, and Marina Berenguer. Recurrence of hepatitis C after liver transplantation. Ann Gastroenterol. 2013;26(4):304–313.

Demetris AJ. Evolution of hepatitis C virus in liver allografts. Liver Transpl. 2009;15 (Suppl 2):S35-S41.

Vasuri F, Morelli MC, Gruppioni E, Fiorentino M, Ercolani G, Cescon M, Pinna AD, Grigioni WF, D’Errico-Grigioni A. The meaning of tissue and serum HCV RNA quantitation in hepatitis C recurrence after liver transplantation: a retrospective study. Dig Liver Dis. 2013;45(6):505-509.

Saxena R, Crawford JM, Navarro VJ, Friedman AL, Robert ME. Utilization of acidophil bodies in the diagnosis of recurrent hepatitis C infection after orthotopic liver transplantation. Mod Pathol. 2002;15(9):897-903.

Gordon FD, Pomfret EA, Pomposelli JJ, Lewis WD, Jenkins RL, Khettry U. Severe steatosis as the initial histologic manifestation of recurrent hepatitis C genotype 3. Hum Pathol. 2004;35(5):636-638.

Brandman D, Pingitore A, Lai JC, Roberts JP, Ferrell L, Bass NM, Terrault NA. Hepatic steatosis at 1 year is an additional predictor of subsequent fibrosis severity in liver transplant recipients with recurrent hepatitis C virus. Liver Transpl. 2011;17(12):1380-1386.

Meriden Z, Forde KA, Pasha TL, Hui JJ, Reddy KR, Furth EE, Wells RG. Histologic predictors of fibrosis progression in liver allografts in patients with hepatitis C virus infection. Clin Gastroenterol Hepatol. 2010;8(3):289-296.

Berenguer M, Schuppan D. Progression of liver fibrosis in post-transplant hepatitis C: Mechanisms, assessment and treatment. Journal of Hepatology. 2013;58(5):1028–1041.

SatapathySK,SclairS,FielMI,DelRíoMartinJ,Schiano T. Clinical characterization of patients developing histologically-proven fibrosing cholestatic hepatitis C post- liver transplantation. Hepatol Res. 2011;41(4):328-39.

Salomao M, Verna EC, Lefkowitch JH, Moreira RK. Histopathologic distinction between fibrosing cholestatic hepatitis C and biliary obstruction. Am J Surg Pathol. 2013;37(12):1837-44.

Shu-Yuan Xiao, Liang Lu and Hanlin L. Wang Fibrosing Cholestatic Hepatitis: Clinicopathologic Spectrum, Diagnosis and Pathogenesis. Int J Clin Exp Pathol. 2008;1(5): 396-402.

Hanouneh IA, Zein NN, Askar M, Lopez R, John B. Interleukin-28B polymorphisms are associated with fibrosing cholestatic hepatitis in recurrent hepatitis C after liver transplantation. ClinTransplant. 2012;26(4):E335-6.

Ueda Y, Yoshizawa A, Ogura Y, Miyagawa-Hayashino A, Haga H, Chiba T, Uemoto S. Plasma cell hepatitis induced by the termination of antiviral therapy for recurrent hepatitis C after living donor liver transplantation. Hepatol Res. 2014;44(10):E279-83.

López Panqueva Rocío del Pilar. Biopsia hepática en la patología del trasplante, período postrasplante temprano, enfoque dirigido al diagnóstico histopatológico y su correlación clinicopatológica. Rev Col Gastroenterol. 2016;31(2):171-181.

Fiel MI, Schiano TD. Plasma cell hepatitis (de-novoautoimmune hepatitis) developing post liver transplantation. Curr Opin Organ Transplant. 2012;17(3):287-92.

Kerkar N, Yanni G’. De ‘novo’ and recurrent autoimmune hepatitis after liver transplantation: A comprehensive review. J Autoimmun. 2016;66:17-24

Tanaka T, Sugawara Y, Kokudo N. Liver transplantation and autoimmune hepatitis. Intractable Rare Dis Res. 2015;4(1):33-8.

Salcedo M, Rodríguez-Mahou M, Rodríguez-Sainz C, Rincón D, Álvarez E, Vicario JL, Catalina MV, Matilla A, Ripoll C, Clemente G, Bañares R. Risk factors for developing de novo autoimmune hepatitis associated with anti-glutathione S-transferase T1 antibodies after liver transplantation. Liver Transpl. 2009;15(5):530-9.

Moreira RK, Salomao M, Verna EC, Brown RS Jr, Lefkowitch JH. The Hepatitis Aggressiveness Score (HAS): a novel classification system for post-liver transplantation recurrent hepatitis C. Am J Surg Pathol. 2013;37(1):104-13.

Manne V, Allen RM, Saab S. Strategies for the prevention of recurrent hepatitis B virus infection after liver transplantation. Gastroenterol Hepatol (N Y). 2014;10(3):175-9.

Maiwall R, Kumar M. Prevention and Treatment of Recurrent Hepatitis B after Liver Transplantation.J Clin Transl Hepatol. 2016;4(1):54-65.

Takaki A, Yasunaka T, Yagi T. Molecular Mechanisms to Control Post-transplantation hepatitis B Recurrence. Int J Mol Sci. 2015;16(8):17494-513.

Lefkowitch Jay H. Scheuer ́s Liver biopsy interpretation. Ninth edition 2016 Elsevier. Cap 16, pag 366-374.

Liberal R, Zen Y, Mieli-Vergani G, Vergani D Liver transplantation and autoimmune liver diseases. Liver Transpl. 2013;19(10):1065-77.

Faisal N, Renner EL. Recurrence of autoimmune liver diseases after liver transplantation.World J Hepatol. 2015;7(29):2896-905.

Edmunds C, Ekong UD Autoimmune Liver Disease Post- Liver Transplantation: A Summary and Proposed Areas for Future Research.Transplantation. 2016;100(3):515-24.

Sebagh M, Castillo-Rama M, Azoulay D, Coilly A, Delvart V, Allard MA, Dos Santos A, Johanet C, Roque-Afonso AM, Saliba F, Duclos-Vallée JC, Samuel D, Demetris AJ. Histologic findings predictive of a diagnosis of de novo autoimmune hepatitis after liver transplantation in adults. Transplantation. 2013;96(7):670-8.

Ranka Vukotic, Giovanni Vitale, Antonia D’Errico-Grigioni, Luigi Muratori, Pietro Andreone. De novo autoimmune hepatitis in liver transplant: State-of-the-art review. World J Gastroenterol 2016;22(10):2906-2914.

Raczyńska J, Habior A, Pączek L, Foroncewicz B, Pawełas A, Mucha K. Primary biliary cirrhosis in the era of liver transplantation. Ann Transplant. 2014;29(19):488-93.

Neuberger J. Recurrent primary biliary cirrhosis. Liver Transpl. 2003;9:539–46.

Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N. Transplantation trends in primary biliary cirrhosis. Clin Gastroenterol Hepatol. 2007;5(11):1313-1315.

Ciesek S, Becker T, Manns MP, Strassburg CP: Anti-parietal cell autoantibodies (PCA) in primary biliary cirrhosis: a putative marker for recurrence after orthotopic liver transplantation? Ann Hepatol. 2010;9(2):181-85.

Hildebrand T et al; German PSC Study Group. Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis: A retrospective multicenter analysis. Liver Transpl. 2016;22(1):42-52.

Ravikumar R, Tsochatzis E, et al. Risk factors for recurrent primary sclerosing cholangitis after liver transplantation. J Hepatol. 2015;63(5):1139-46.


Métricas de artículo

Cargando métricas ...

Metrics powered by PLOS ALM

Enlaces refback

  • No hay ningún enlace refback.


Copyright (c) 2017 Revista Colombiana de Gastroenterología

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.

ISSN versión impresa 0120-9957

ISSN versión en línea 2500-7440

  Licencia de Creative Commons
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.