Morphometric image analysis and eosinophil counts in human liver allografts

Abstract

Histology of liver allografts is the gold standard for diagnosis of acute cellular rejection. However, scoring the severity of rejection and distinguishing it from other infiltrations is not easy. Only one group has evaluated biopsies morphometrically and also suggested that eosinophils are a specific diagnostic feature. We quantitated eosinophil count in 92 biopsies in a group of 25 patients and, in another group of 30 patients, used morphometric image analysis to measure the cross-sectional area and cell density in each portal tract in day 5 protocol liver biopsies. Rejection was diagnosed by pathological evaluation confirmed with clinical and biochemical graft dysfunction graded histologically into mild or moderate-to-severe. The control groups were five patients with no rejection, nine patients with CMV infection, and eight biopsies in eight patients for whom the cause of the liver dysfunction was obscure. The cross-sectional area, the inflammatory cell count of each portal tract and the mean portal tract inflammatory cell density (cells/mm2) increased with the severity of rejection. In each case the regression coefficient was statistically significant. Correlating the mean of the total inflammatory cell count with the mean of the portal inflammatory cell density (cell/mm2) gave far better separation of the mild rejection and moderate-to-severe rejection groups. Eosinophils were specific for the presence of acute cellular rejection and increased with the severity of rejection. They were absent in the no rejection group, in the CMV group and in those with obscure liver dysfunction. The eosinophil count fell markedly following treatment of rejection.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…A specific serum marker of ACR, which obviates the need for biopsy, is easily measured, and of low cost would be a valuable clinical tool. Graft and blood eosinophilia has been identified as an independently associated feature of ACR in the context of liver transplantation (2)(3)(4). In this study, we confirm these findings, but furthermore, we assess the role of an elevated eosinophil count in predicting the severity of ACR.…”

“…Blood eosinophils in response to treatment Blood eosinophils fall with corticosteroid treatment (4,5).…”

“…Previous studies have shown that blood and graft eosinophils decrease when ACR is treated using corticosteroids (4,5). However, the interpretation of these studies is complicated by the fact that corticosteroids may themselves induce eosinopenia (6).…”

Eosinophils in acute cellular rejection in liver allografts

“…39 Datta Gupta et al 5 from the Royal Free Hospital, using a stepwise regression analysis, showed that the presence of eosinophils in the biopsy were an independent diagnostic marker of acute cellular rejection, and this is why it is included in the scoring system developed at the Royal Free Hospital. 5 Ben-Ari et al 40 from the same center, using a morphometric image analysis, confirmed that graft eosinophil levels that increased with the severity of rejection were one of the most specific markers of acute cellular rejection. As in the case of renal allograft rejection biopsies, the timing of the appearance of peripheral eosinophilia differs in different studies.…”

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

“…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.…”