Monitoring eosinophil activation and liver function after liver transplantation

Portal tract eosinophil infiltration and an increase in the blood eosinophil count (EOS) have been shown to be specific markers of liver allograft rejection. The graft eosinophil infiltration is associated with the local release of eosinophil cationic protein. Therefore, serum eosinophil cationic protein concentration (ECP) is a potential marker for acute allograft rejection. We investigated the chronological relationship among and diagnostic value of serial changes in EOS, ECP, and liver function tests (LFTs) following liver transplantation.

EOS, ECP, serum alpha-glutathione S-transferase concentration, and conventional LFTs were measured in serial samples collected over the first 3 postoperative months following 58 liver transplants. The diagnostic potential of each test, alone or in combination, was reviewed over the entire follow-up period.

EOS and ECP increased at a median period of 3.5 and 4 days, respectively, before the diagnosis of acute rejection, and this increase was significantly earlier than the corresponding changes in LFTs (P<0.05). There was a significant correlation between the day of the first increase in EOS and alpha-glutathione S-transferase (rs=0.535; P=0.009) and EOS and alanine transaminase (rs=0.629; P=0.004). The optimum combination of tests for the diagnosis of acute rejection was an increase in both EOS and GST with a predictive efficiency of 84%.

Increases in EOS and ECP are early indicators of acute liver allograft rejection and precede evidence of hepatocellular damage. However, an increase in ECP was also frequently associated with infection. Therefore, we recommend the regular monitoring of EOS in conjunction with routine LFTs after liver transplantation as an aid to the early diagnosis of acute rejection.