BIOPSY EOSINOPHILIA: A PREDICTOR OF RENAL GRAFT DYSFUNCTION
A. Halon1, D. Jezior2, M. Boratynska2, D. Kaminska2, M. Klinger2, J. Rabczynski 1 , D. Patrzałek 3 and P. Szyber3
1 Department of Pathological Anatomy,2 Department of Nephrology and Transplantation Medicine and 3 Department of Vacsular, General and Transplant Surgery, Wroclaw Medical University, Wroclaw, Poland.
Eosinophils, like mononuclears are effector cells of acute rejection. The aim of the research was to assess the impact of eosinophilia in renal biopsy during acute rejection period on severity and reversibility of the rejection and long term graft outcome.
Material: Study entailed 165 renal graft recipients transplanted in 2000-2002, whose biopsy revealed acute rejection. Results of 50 patients with tissue eosynophilia >4cells/mm2 were compared with a control group of 50 patients. Patients were treated with Tacrolimus/CsA or CellCept/Azathioprine steroid-containing regimens. Steroid-free therapy was conducted in 11 and 8 patients in the eosinophilia and control group respectively. Average biopsy time was 100 and 80 days respectively. Half of the patients with eosinophilia and 33% from control group had biopsy performed in DGF period.
Results: Tissue eosinophilia was found in 50 out of 165 patients (29%), 6 had eosinophilia <10mm-2, 29 had 10-100mm-2. Eosinophilia >100mm-2 was found in 13 patients including 3 with >300 cells/mm2. Number of eosinophils and rejection episodes were significantly higher in patients treated with steroid-free therapy (p<0.03). In patients with eosinophilia frequency of incidences of rejection was 1.8 per patient vs. 1.3 per patient in the control group (p<0.04). Severity of acute rejection in Banff scale was also higher (p<0.008) and clinical courses of the rejections were more severe. Serum creatinine levels 6 months after the diagnosis of rejection were 2.2mg/dl vs 1.8mg/dl. Chronic rejection occurred in 25% patients with eosinophila and 11% of the control group within 1 posttransplant year. Immunological graft loss occurred in 5 patients with tissue eosynophilia vs. 1 patient in the control group within 6 months.
Conclusions: Biopsy eosinophilia is a negative predictor indicating more severe course of acute rejection and worse response to antirejection treatment. It also expresses a threat of chronic graft dysfunction.
SUBMISSION OF ABSTRACT FOR POSTER PRESNTATION
BIOPSY EOSINOPHILIA: A PREDICTOR OF RENAL GRAFT DYSFUNCTION.
Agnieszka Halon , Dominika Jezior , Maria Boratynska , Dorota Kaminska , Marian Klinger , Jerzy Rabczynski , Dariusz Patrzałek , Piotr Szyber
The first author and person to contact:
Department of Pathological Anatomy
Wroclaw Medical University
50-368 Wroclaw, POLAND
Phone: (+48/71) 784 12 40
Fax: ( +48/71) 784 00 57