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Abstract: SA-PO460

Eosinophil-Rich Inflammation in Allograft Renal Biopsies: An Analysis of Clinical Significance and Correlation with Rejection

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational


  • Vasanth, Payaswini, Emory University, Atlanta, Georgia, United States
  • Ellis, Carla L., Emory University, Atlanta, Georgia, United States

In this study we investigate the significance of interstitial eosinophilic inflammation in renal allograft and its association with rejection, response to treatment, risk of subsequent rejections, and allograft outcome.


We studied 26 kidney transplant pts between 2012-17 with AKI who underwent biopsies. The biopsies showed clusters of interstitial eosinophils histologically, with or without evidence of ACR, AMR, or both. Allograft function at the time of the biopsy was assessed by SCr and by its change from baseline. After initial treatment, pts were categorized as,
- Complete Responders (CR): SCr returned to baseline
- Partial Responders (PR): SCr decreased to a level that was greater than 50% of SCr at the time of biopsy, but never returned to baseline.
- Non Responders (NR): SCr remained at or above SCr at the time of biopsy.


22 out of the 26 biopsies with eosinophils had rejection [Borderline 10(45%), 1A 1 (5%),1B 5(23%), 2A 1(5%), 2B 2(9%), AMR+ACR 3(14%)]. Allograft response to treatment of underlying and incidents of subsequent rejection is shown in Table 1.
13 of 22 pts with eosinophilia and rejection had subsequent rejections. 7 (4 NR, 3 PR) pts progressed to needing RRT, of which 4 lost allograft within 2 yrs.
22%(5) of pts with eosinophilic rejection had h/o BK viremia, 22%(5) had h/o CMV viremia, of which 75% were NR. 50%(11) of the pts who had eosinophilic rejection had history of recurrent UTIs. One pt with HIV had severe rejection with plasma cells and allograft loss within a year of transplantation.
61% (16) pts were on drugs that are shown to be associated with AIN especially PPIs. Only 3%(1) pts had peripheral eosinophilia.


Of the 26 pts with eosinophilic inflammation in their allograft biopsy we note a higher incidence of ongoing rejection and risk of developing subsequent rejection and allograft loss. Pts with history of infection (UTIs, BK, CMV) had higher incidence of underlying rejection with eosinophilic infiltrates.

Table 1: Allograft response to treatment of underlying and incidents of subsequent rejection
 With RejectionSubsequent Rejection
 # of Pts% of total pts# of Pts% of total pts
Total Pts:22 13