Case Report
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World J Gastroenterol. Jun 14, 2014; 20(22): 7067-7074
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.7067
Expression of alpha smooth muscle actin in living donor liver transplant recipients
Masataka Hirabaru, Kyoko Mochizuki, Mitsuhisa Takatsuki, Akihiko Soyama, Taiichiro Kosaka, Tamotsu Kuroki, Isao Shimokawa, Susumu Eguchi
Masataka Hirabaru, Kyoko Mochizuki, Mitsuhisa Takatsuki, Akihiko Soyama, Taiichiro Kosaka, Tamotsu Kuroki, Susumu Eguchi, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
Isao Shimokawa, Department of Investigative Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
Author contributions: Hirabaru M and Eguchi S contributed equally to this work; Hirabaru M, Mochizuki K and Eguchi S designed the study; Hirabaru M, Eguchi S, Mochizuki K, Takatsuki M, Soyama A, Kosaka T, Kuroki T, Shimokawa I and Eguchi S performed the study and analyzed the data; and Hirabaru M and Eguchi S wrote the manuscript.
Correspondence to: Susumu Eguchi, MD, PhD, Department of Surgery, Nagasaki University Graduate School of Biomedical sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. sueguchi@nagasaki-u.ac.jp
Telephone: +81-95-8197316 Fax: +81-95-8197319
Received: October 22, 2013
Revised: December 31, 2013
Accepted: February 26, 2014
Published online: June 14, 2014
Abstract

Recently, there have been reports from liver biopsies that showed the progression of liver fibrosis in liver transplant patients after the cessation of immunosuppression. Herein, we focused on activated hepatic stellate cells expressing alpha smooth muscle actin (α-SMA) to understand the correlation between immunosuppressant medication and liver fibrosis. The study enrolled two pediatric patients who underwent living donor liver transplantation and ceased immunosuppressant therapy. The number of α-SMA-positive cells in the specimens obtained by liver biopsy from these two patients showed a three-fold increase compared with the number from four transplanted pediatric patients who were continuing immunosuppressant therapy. In addition, the α-SMA-positive area evaluated using the WinRooF image processing software program continued to increase over time in three adult transplanted patients with liver fibrosis, and the α-SMA-positive area was increasing even during the pre-fibrotic stage in these adult cases, according to a retrospective review. Therefore, α-SMA could be a useful marker for the detection of early stage fibrosis.

Keywords: Living donor liver transplantation, Liver fibrosis, Immunosuppressant therapy, Alpha smooth muscle actin, Hepatic stellate cells

Core tip: The primary finding presented in this case report is that there is that the cessation of immunosuppressant therapy may promote liver fibrosis in patients after liver transplantation, even though normal liver function is maintained. In addition, the alpha smooth muscle actin (α-SMA)-positive area increased during the pre-fibrotic stage. Therefore, α-SMA may serve as a useful marker to detect early stage fibrosis.