Applications and Limitations of Blood Eosinophilia for the Diagnosis of Acute Cellular Rejection in Liver Transplantation

Is blood eosinophilia an effective predictor of acute rejection in living donor liver transplantation?*

“…The sensitivity and specificity of preoperative eosinophilia (eosinophil counts >130 mm 3 ) to predict ACR was 33% and 65%, respectively. The eosinophil counts >400 mm 3 3 days before and on the day of biopsy was associated with the severity of ACR (P < 0.0001). The sensitivity to predict ACR was 26% and 33%, and the specificity, 94% and 93%, respectively.…”

“…Here, the number of eosinophils was evaluated as AEC or relative eosinophil count (REC: AEC · 100/total leukocyte count). Postoperative eosinophilia was defined as AEC more than 400/mm 3 and/or REC more than 4% [3].…”

“…Early diagnosis is necessary for prompt treatment, which must be based on liver biopsy. Several reports indicate a relationship between blood eosinophilia and acute rejection in liver transplantation [1][2][3][4]. Infiltration of eosinophils into the graft and peripheral blood eosinophilia might relate to ACR.…”

Liver Biopsy in Transplantation: Nonalcoholic Fatty Liver Disease and the Eosinophils

“…Barnes et al reported that HCV-positive patients with ACR are less likely to have blood eosinophilia than HCV-negative patients with ACR. They thus proposed that the eosinophil response might be suppressed in HCV-positive patients with ACR, and that ACR might be overdiagnosed if based on histopathology in patients with normal eosinophil levels 36 . Similarly, Kishi et al 47 reported that HCV-positive patients diagnosed with ACR had significantly higher blood eosinophil counts on the day of biopsy than HCV-positive patients without ACR.…”

“…To facilitate the diagnosis of ACR, the efficacy of blood and/or histologic eosinophilia has been reported in several studies [29][30][31][32][33][34][35][36][37][38] (Table 3). In these studies, sensitivity and specificity of blood eosinophilia to predict ACR before biopsy were reported to be 32% to 96% and 63% to 97%, respectively, while those of histologic eosinophilia were 54% to 92% and 65% to 98%, respectively.…”