Peripheral eosinophil count both before and after liver transplantation predicts acute cellular rejection

Abstract

Acute cellular rejection is common after orthotopic liver transplantation and an important cause of graft dysfunction. Eosinophils, potent mediators of tissue damage, have been implicated in the pathogenesis of acute rejection. We studied 55 patients, all of whom had a protocol biopsy 7 days after transplantation and whose peripheral eosinophil count was monitored daily for 11 days after transplantation. Patients were divided clinicopathologically into two groups: group A, without rejection, group B, with rejection. Group B (36% of patients) developed rejection within the 11-day study period. The pretransplant eosinophil count was significantly higher in group B, compared with group A (0.31 6 0.08 v 0.10 6 0.01 (310 9 /L), p , .001). After transplantation, the eosinophil count fell to low levels in both groups. By day 3 there was a statistically significant rise in the eosinophil count in group B compared with group A, with a maximum at day 7 [0.51 6 0.06 v 0.26 6 0.03 (310 9 /L) p , .001]. After treatment with steroids, the eosinophil count dropped to values similar to those in group A and remained low thereafter in 16 of 20 patients. Four patients had a second episode of rejection; in each of these, eosinophils were raised again and decreased with resolution of the rejection. An eosinophil count threshold of 0.13 (310 9 /L) before transplantation and 0.33 (310 9 /L) on day 7 after transplantation predicted the development of rejection (sensitivity 72/70%, specificity 66/63%, negative predictive value 82/79%). We conclude that a raised eosinophil count is associated with acute rejection. The raised eosinophil count before transplantation in group B suggests that these patients are predisposed to acute rejection, and earlier intervention may be indicated.

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

“…In most studies, eosinophilia preceded ACR by 2-4 days [1,5]. One report demonstrated a close relationship between pretransplantation peripheral blood eosinophilia and postoperative ACR [6]. All of these reports, however, were based on data from deceased donor liver transplantation.…”

“…Few studies have evaluated whether preoperative eosinophilia predicts ACR [6]. Nagral et al [2] reviewed 129 biopsy cases.…”

“…Preoperative eosinophilia was defined as absolute eosinophil count (AEC) >130 mm 3 [6]. The relationship of eosinophilia 3 days before or on the day of biopsy and ACR grouped by grade was examined.…”

Eosinophils in acute cellular rejection in liver allografts

“…Another recent study showed that a blood eosinophil count of more than 130/µL before transplantation predicted subsequent development of acute rejection with a sensitivity of 72%, specificity of 66%, and a negative predictive value of 82%. 44 In another transplantation setting, eosinophils were found in the bile duct epithelial layer and around bile ducts in portal tracts, implying damage to the bile ducts, in experimental graft-versus-host disease in mice with a bone marrow transplant. 45 …”

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.…”