Singh N, Gayowski T, Marino I R
Veterans Affairs Medical Center and University of Pittsburgh, Thomas E. Starzl Transplantation Institute, Pennsylvania 15240, USA.
Transplantation. 1998 Jan 27;65(2):199-203. doi: 10.1097/00007890-199801270-00009.
Leukocytosis without a recognizable etiology often poses a diagnostic and therapeutic dilemma in transplant recipients.
Fifty consecutive episodes of leukocytosis in 47 liver transplant recipients were prospectively assessed.
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.
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.
在移植受者中，病因不明的白细胞增多症常常给诊断和治疗带来难题。
对47例肝移植受者连续发生的50次白细胞增多症发作进行前瞻性评估。
70%（33/47）的患者出现白细胞增多症，而30%（14/47）的患者从未发生过白细胞增多症。三种不同病因占发作次数的82%。32%（16/50）的发作发生在移植后1至3天，无发热，且在2天内自行缓解。感染占白细胞增多症发作次数的28%（14/50）；发病的中位时间为移植后25天，57%的患者出现发热。22%（11/50）的发作中，在移植后7至14天出现特征性白细胞增多症（无感染或排斥反应记录），无发热，且无需使用抗生素即可自行缓解；这些患者的血小板计数显著高于术后患者（P < 0.01）或感染性白细胞增多症患者（P < 0.05）。移植前脾功能亢进的缓解，伴有脾内扣押的粒细胞和血小板释放，可能是其原因。排斥反应和大剂量使用皮质类固醇分别占发作次数的4%和8%。
白细胞增多症的发病时间和模式对于评估移植后白细胞增多症具有重要价值。术后即刻以及移植后7至14天，白细胞增多但病情稳定、无发热或无感染记录的患者无需经验性使用抗生素治疗。
