title: Applications and limitations of blood eosinophilia for the diagnosis of acute cellular rejection in liver transplantation.
abstract: This study evaluates the predictive value of the blood eosinophil count in the diagnosis of acute cellular rejection, its value as a marker of response to treatment, the diagnostic use in a subgroup of patients with normal transaminases and compares blood eosinophilia in patients with and without hepatitis C virus infection. A consecutive cohort of 101 liver transplant patients, 275 liver biopsies, and blood eosinophils recorded on the day or one day before biopsy were analyzed. An elevated eosinophil count has a positive predictive value for acute cellular rejection of 82%. A normal eosinophil count excludes moderate/severe rejection with a predictive value of 86%. The eosinophil count decreases in 69% of patients following treatment of acute cellular rejection with corticosteroids irrespective of treatment outcome. Acute cellular rejection in the presence of an elevated eosinophil count occurs significantly less often (p = 0.007) in patients with hepatitis C virus. An elevated eosinophil count is a valuable marker of acute cellular rejection. However, blood eosinophil levels should not be used to predict acute cellular rejection following treatment with corticosteroids. Blood eosinophilia, seen less often in patients with hepatitis C virus, may reflect an over-diagnosis of acute cellular rejection in these patients.
authors.affiliation: Liver Transplant Unit, Royal Free Hospital, Pond Street, London, UK. ellie.barnes@ntlworld.com
authors.forename: Eleanor J
authors.initials: EJ
authors.lastname: Barnes
authors.forename: Marwa M
authors.initials: MM
authors.lastname: Abdel-Rehim
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Goulis
authors.forename: Mona
authors.initials: M
authors.lastname: Abou Ragab
authors.forename: Susane
authors.initials: S
authors.lastname: Davies
authors.forename: Amar
authors.initials: A
authors.lastname: Dhillon
authors.forename: Brian
authors.initials: B
authors.lastname: Davidson
authors.forename: Keith
authors.initials: K
authors.lastname: Rolles
authors.forename: Andrew
authors.initials: A
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D015331:Cohort Studies; D004802:Eosinophilia / Q000150:complications*; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006526:Hepatitis C / Q000150:complications / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase