Blood and Graft Eosinophilia as a Rejection Index in Kidney Transplant

Abstract

The relevance of eosinophilia in the physiopathology of transplant rejection has yet to be established. The appearance of eosinophilia has been occasionally associated with an adverse prognosis on graft rejection episodes. The aim of the present study was to evaluate the role and prognostic implications of blood and graft eosinophilia in kidney transplant rejection. We have examined the intrarenal infiltrate in 173 fine-needle aspiration biopsies from 36 consecutively transplant patients, and blood samples obtained simultaneously with fine-needle aspirations. Two different immunosuppressive regimens were administered: triple therapy (azathioprine + prednisone + antilymphocytic globulin) in patients with posttransplant acute tubular necrosis and cyclosporine A monotherapy in the rest of the patients. Comparing the two immunosuppressive groups, more elevated eosinophil values were observed in the monotherapy group during stable graft and also at the rejection episode. In the monotherapy group, a significant increase in the eosinophil values, in peripheral blood samples and in the intragraft infiltrates were noted at the rejection episode with respect to the stable situation. Following pulsed-steroid treatment an immediate disappearance of the eosinophils was evident. In contrast, no differences could be demonstrated between these two clinical situations in the TT group. Higher rates of eosinophils in the intrarenal infiltrate with respect to peripheral blood samples were observed during rejection episodes, suggesting some role of the eosinophils in the physiopathology of graft rejection. Higher values of eosinophils in graft infiltrates at rejection episode and a rapid reappearance of eosinophils in the infiltrate following pulsed-steroid treatment, were correlated with an unfavorable prognosis of graft rejection. In conclusion, the eosinophil counts (blood and graft) could be adopted as an additional criteria of immunoactivation in transplant patients treated with cyclosporine A monotherapy, and the rapid reappearance of eosinophils following pulsed-steroid treatment represents a useful negative prognostic predictor in acute rejection management.

Eosinophilic pulmonary syndrome as a manifestation of GVHD following hematopoietic stem cell transplantation in three patients

“…An association among peripheral eosinophilia, graft eosinophilia and rejection has also been reported in renal transplant recipients. 15 Blood eosinophilia is a marker of cardiac rejection, and the degree of eosinophilia correlates with severity of rejection. 4 Common findings among these three patients' eosinophilic pulmonary syndrome following HSCT included male sex, use of blood HPC rather than BM, previous or concurrent active chronic GVHD involving skin, peripheral blood eosinophilia and the occurrence of the pulmonary syndrome after day 100 post transplant ( Table 1).…”

Inflammatory cells and activation markers in BAL during acute rejection and infection in lung transplant recipients: a prospective, longitudinal study

“…The eosinophil is known to release potent cytotoxic granule products associated with the cellular damage seen in a variety of inflammatory diseases, including bronchial asthma [17,18]. Several studies have hypothesized that the eosinophil could act as an effector-cell in the inflammation present during acute graft rejection [7,14,19].…”

Eosinophils in acute cellular rejection in liver allografts

“…Peripheral eosinophilia occurred 2 to 4 days before the onset of graft dysfunction 27,32 or coincided with the onset of rejection as diagnosed by fine-needle aspiration cytology of renal allografts. 29 Cytodiagnostic examination of the urine has also yielded eosinophiluria of greater than 20 per 10 high-power fields as an indicator of kidney-pancreas transplant rejection. 33 Urine eosinophils antedated the physical signs of rejection and the increase in the serum creatinine level by 3 to 5 days.…”