Peripheral eosinophilia and eosinophilic gastroenteritis after pediatric liver transplantation

Abstract

Reports indicate peripheral eosinophilia (PE) and gastrointestinal eosinophilic inflammation can occur after pediatric liver transplantation. The incidence of these conditions, potential risk factors, and the impact of PE and gastrointestinal eosinophilic inflammation on liver transplant outcome were determined in this pediatric liver transplant program. Medical records of liver transplant recipients from 1 to 97 and from 12 to 99 were reviewed. Fifty-seven transplants on 54 patients were performed during the study period. Fifty-three patients were evaluated; all had normal pre-transplantation peripheral eosinophil counts. PE of > 10% developed in 28% of patients. Using this definition, all such identified patients had absolute eosinophil counts of > 350/mm3. History of immediate hypersensitivity did not differ between patients with or without eosinophilia. Gastrointestinal endoscopy and biopsy was performed in 23 patients with gastrointestinal complaints. Of those, six had eosinophilic gastroenteritis and all six had PE. Compared with patients without eosinophilia, those with PE were younger at the time of transplantation (p < 0.05), had more frequent rejection (p < 0.01), were more commonly managed with tacrolimus-based immunosuppression (p < 0.001), and experienced more frequent episodes of detectable EBV viral load (p < 0.04). Patients with eosinophilic gastroenteritis were more frequently retransplanted (p < 0.006). PE associated with symptomatic eosinophilic gastroenteritis is common after pediatric liver transplantation. Age at transplant, frequency of rejection episodes, tacrolimus-based immunosuppression, and EBV viral load may be associated with the development of this condition. There may be higher rates of graft loss in such patients. Whether innate immune responsiveness or an acquired immune dysregulation accounts for these findings merits further evaluation.

Food Allergy: Transfused and Transplanted

“…Fifty-two of the 163 foods initially avoided were successfully reintroduced, with 17 of the 25 children having been able to reintroduce at least one food to their diet. The tendency for the development of eosinophilic gastrointestinal disease in these patients has been reported by others [31,32]. In the only prospective study to date, Ozbeck et al [33•] observed 28 children with a mean age of 4.96±0.76 years who underwent orthotopic liver transplantation from donors who were not food allergic.…”

Incidence and Prevalence of Eosinophilic Esophagitis in Children

“…The prevalence of EoE ranged from 2.4% to 3.0% for children post-liver transplantation (26,27). In liver transplant recipients, de novo development of food allergy and gastrointestinal eosinophilic inflammation may be attributed to the potential effect of tacrolimus suppression of T H 1 response and promotion of T H 2 signal pathways (26,(45)(46)(47). The prevalence of EoE was 8% among children with UC (28).…”

Significance of eosinophilia after stem cell transplantation as a possible prognostic marker for favorable outcome

“…Only younger patients were significantly associated with eosinophilia (Table 1) as has been previously reported. 19 This observation may be linked to the fact that a better SCT prognosis is predicted for younger patients in some genetically based diseases such as congenital immunodeficiency. 20 In conclusion, we have demonstrated that patients with eosinophilia after SCT treatment show an apparently higher survival rate and event-free survival rates compared to those without eosinophilia after SCT.…”