Causes of leukocytosis in liver transplant recipients: relevance in clinical practice.

BACKGROUND

Leukocytosis without a recognizable etiology often poses a diagnostic and therapeutic dilemma in transplant recipients.

METHODS

Fifty consecutive episodes of leukocytosis in 47 liver transplant recipients were prospectively assessed.

RESULTS

Leukocytosis was documented in 70% (33/47) of the patients, whereas 30% (14/47) of the patients never developed leukocytosis. Three distinctive etiologies accounted for 82% of the episodes. Thirty-two percent (16/50) of the episodes occurred between 1 and 3 days after transplantation, were unaccompanied by fever, and resolved spontaneously within 2 days. Infections accounted for 28% (14/50) of the episodes of leukocytosis; median time to onset was 25 days after transplantation, and fever occurred in 57%. In 22% (11/50) of the episodes, a characteristic leukocytosis occurred 7-14 days after transplantation (in the absence of documented infections or rejection) that was unaccompanied by fever, and resolved spontaneously without antibiotics; the platelet count of these patients was significantly higher than those of postoperative (P < 0.01) or infectious leukocytosis (P < 0.05). Resolution of pretransplant hypersplenism, with the release of sequestered splenic granulocytes and platelets, was the likely cause. Rejection and corticosteroid boluses accounted for 4% and 8% of the episodes, respectively.

CONCLUSIONS

Timing of onset and awareness of the patterns of leukocytosis can be valuable in the evaluation of posttransplant leukocytosis. Stable patients with leukocytosis, but without fever or documented infections, in the immediate postoperative period and between 7 and 14 days after transplantation, need not be empirically treated with antibiotics.