Should eosinophilia be included in the Banff classification of renal allograft rejection?
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Oct) 8:701A 1997
It is well known that acute cellular rejection in the allograft kidney results in inflammatory infiltrates rich in small round lymphocytes, transformed cells, immunoblasts, and, in some cases, plasma cells or neutrophils. The presence of eosinophils has been reported, but is not as widely recognized.
Roberts et al. enumerated the number of eosinophils in 47 renal allograft biopsies showing acute tubulointerstitial rejection, and 62 biopsies with acute vascular rejection. Tissue eosinophilia (> 4 cells/high power field of cortex) was found in 7/47 (15%) and 21/54 (39%) of biopsies in these two groups respectively. This finding was also noted in 6/7 patients who had an initial episode of acute tubulointerstitial rejection followed by a subsequent episode of acute vascular rejection.
Comment: This study confirms prior reports that the presence of eosinophils in renal allograft biopsies tends to be associated with higher grades of rejection. Hence, it would be reasonable to mention this finding in the pathology report, when it is present. However, it remains to be shown whether eosinophils predict graft survival independent of the occurrence of vascular rejection. Indeed, in the group of patients reported, tissue eosinophilia did not correlate with ultimate clinical outcome. (Parmjeet Randhawa, M.D., Presbyterian-University Hospital, Pittsburgh, PA)
References:
Solez K, Axelsen RA, Benediktsson H et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Banff working classification of kidney transplant pathology. Kidney Int 1993;44:411-422.
Hongwei W, Nanra RS, Stein A, Avis L, Price A, Hibberd AD. Eosinophils in acute renal allograft rejection. Transplant Immunol 1994;2:41-46.
Hallgren R, Bohman SO, Fredens K. Activated eosinophil infiltration and deposits of eosinophil cationic protein in renal allograft rejection. Nephron 1991;59:266-270.
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ASN 30th Annual Meeting, San Antonio
Transplant : Transplantation