Prediction of acute cellular rejection by peripheral blood eosinophilia in pediatric living donor liver transplantation.
BACKGROUND
Acute cellular rejection (ACR) is a common cause of morbidity following liver transplantation. Several reports have evaluated the predictive value of peripheral blood eosinophilia as a simple noninvasive diagnostic marker for ACR. This study examined whether the relative eosinophil counts (REC) predicted ACR in pediatric living donor liver transplantation (LDLT).


METHODS
One hundred three patients underwent LDLT between May 2001 and December 2007. ACR were diagnosed based on the pathological findings.


RESULTS
The incidence of ACR was 46.6% (48/103); ACR was diagnosed an average of 13.5 days after LDLT. The average REC at 4 and 2 days before the onset ACR (n = 39) within 30 postoperative day (POD) was 4.3% and 7.3%, respectively, and 9.0% at the onset. Patients with ACR showed significantly higher levels of REC compared with those free of ACR (P = .039). REC thresholds of 10% at POD 7 displayed a sensitivity and specificity of ACR detection of 80% and 75%, respectively. Moreover, the accumulated morbidity ratio of ACR within 30 POD was significantly higher with REC >10% at POD 7 (P = .007).


CONCLUSIONS
ACR within POD 30 should be considered when REC is >10% at POD 7 after LDLT.
Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan. yuki371@jichi.ac.jp
Y
Y
Sanada
K
K
Ushijima
K
K
Mizuta
T
T
Urahashi
Y
Y
Ihara
T
T
Wakiya
N
N
Okada
N
N
Yamada
S
S
Egami
S
S
Hishikawa
S
S
Otomo
K
K
Sakamoto
Y
Y
Yasuda
H
H
Kawarasaki
D000208:Acute Disease; D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D004802:Eosinophilia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D007111:Immunity, Cellular; D007223:Infant; D007564:Japan; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology*; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome