BLOOD AND GRAFT EOSINOPHILIA AS A REJECTION INDEX IN KIDNEY-TRANSPLANT

The relevance of eosinophilia in the physiopathology of transplant rej ection has yet to be established. The appearance of eosinophilia has b een occasionally associated with an adverse prognosis on graft rejecti on episodes. The aim of the present study was to evaluate the role and prognostic implications of blood and graft eosinophilia in kidney tra nsplant rejection. We have examined the intrarenal infiltrate in 173 f ine-needle aspiration biopsies from 36 consecutively transplant patien ts, and blood samples obtained simultaneously with fine-needle aspirat ions. Two different immunosuppressive regimens were administered: trip le therapy (azathioprine + prednisone + antilymphocytic globulin) in p atients with posttransplant acute tubular necrosis and cyclosporine A monotherapy in the rest of the patients. Comparing the two immunosuppr essive groups, more elevated eosinophil values were observed in the mo notherapy group during stable graft and also at the rejection episode. In the monotherapy group, a significant increase in the eosinophil va lues, in peripheral blood samples and in the intragraft infiltrates we re 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 demonst rated between these two clinical situations in the TT group. Higher ra tes of eosinophils in the intrarenal infiltrate with respect to periph eral blood samples were observed during rejection episodes, suggesting some role of the eosinophils in the physiopathology of graft rejectio n. Higher values of eosinophils in graft infiltrates at rejection epis ode and a rapid reappearance of eosinophils in the infiltrate followin g pulsed-steroid treatment, were correlated with an unfavorable progno sis of graft rejection. In conclusion, the eosinophil counts (blood an d graft) could be adopted as an additional criteria of immunoactivatio n in transplant patients treated with cyclosporine A monotherapy, and the rapid reappearance of eosinophils following pulsed-steroid treatme nt represents a useful negative prognostic predictor in acute rejectio n management.