Predicting severity and clinical course of acute rejection after liver transplantation using blood eosinophil count

Abstract

Summary Acute cellular rejection remains an important source of morbidity after liver transplantation, particularly if rejection is moderate or severe, as this usually is treated. Currently liver biopsies are seldom performed, so diagnostic noninvasive markers would be useful. We evaluated 690 consecutive first liver transplant patients to assess whether peripheral eosinophilia could predict moderate‐severe rejection and its course. A protocol biopsy was performed 6 ± 2.5 days after transplant. A second biopsy was taken 6.1 ± 2 days after the first in 487 patients to assess histological improvement. Liver function tests, peripheral eosinophil count and changes between first and second biopsy, were evaluated using logistic regression. Histological rejection was present in 532 patients (77.1%), with moderate (30.6%) and severe rejection (3.9%). Peripheral eosinophil count was strongly associated with moderate‐severe rejection (OR = 2.15; P = 0.007), although the area under ROC curve (AUROC) was 0.58. On second biopsy, rejection improved in 119 (24.4%) patients. The delta in eosinophil count between the first and second biopsies was the only independent predictor of histological improvement (OR = 3.12; P = 0.001), irrespective of whether bolus steroids were used (OR = 2.77; P = 0.004); AUROC was 0.72. Peripheral eosinophilia is not sufficiently predictive of moderate‐severe histological rejection. However the changes in eosinophil count over time can accurately predict the histological resolution of rejection.

Eosinophil count, allergies, and rejection in pediatric heart transplant recipients

“…[32][33][34][35] Nagral et al 36 showed that an eosinophil count 4400/mm 3 could predict rejection beginning 2 days before biopsy. These studies, however, used the maximum eosinophil count, focusing on an acute rise in the eosinophil count at the time of ACR, rather than examining the "average" eosinophil counts longitudinally.…”

Conversion From Sirolimus to Everolimus in Long-Term Liver Graft Recipients

“…As an alternative, detection of putative rejection episodes was based on biochemical surveillance. It was shown that biochemical parameters are of limited sensitivity and specificity in the detection of liver graft rejection episodes . Therefore, less severe and transient rejection episodes during the study period cannot be completely excluded.…”

Usefulness of liver stiffness measurement during acute cellular rejection in liver transplantation

“…Although acute liver rejection is a histological diagnosis and a liver biopsy is considered essential when evaluating the efficacy of immunosuppressors, the use of noninvasive methods for the diagnosis of rejection can be potentially useful in clinical practice, particularly considering the well‐known limitations of liver biopsy . In fact, several studies have addressed the role of routine biological markers, such as blood eosinophils, bilirubin, GGT, or AP, in the diagnosis and prognosis of ACR and also in their ability to predict response to treatment . However, none of these biomarkers has shown enough accuracy to be incorporated into clinical practice as a reliable tool, even to select patients to undergo liver biopsy for a suspect of rejection.…”