PURPOSE: Leukocytosis (WBC>=12,000) is a frequent finding in the early postoperative period after lung transplantation (LT). Some LT recipients will develop leukocytosis without a recognizable cause, despite extensive investigation. This implies a clinical dilemma in terms of treatment and need for extensive work up. The aim of the study was to evaluate the etiology, timing of onset and clinical outcome of leukocytosis seen during the first two weeks after LT.
METHODS: The medical records and LT database of 83 consecutive patients, who underwent LT from July-2001 to March-2005 at Mayo Clinic Jacksonville, were reviewed. All patients received a triple immunosuppressive therapy and antimicrobial prophylaxis. Bronchoscopies and cultures were done at least weekly during the early postoperative period.
RESULTS: 57% were male and 43% female. Their mean age was 56+13 years (Range:19–73). Leukocytosis was documented in 76/83 (92%) of the patients. The trends of the leukocytes values in both groups are showed in fig 1. The etiology of the leukocytosis was identified in 74% (56/76) of the episodes: 18% (14/76) early postoperative stress (procedure and steroid induced), 14% (11/76) infection, 9% (7/76) reperfusion injury, 9% (7/76) rejection, 3% (2/76) second surgery, and 20% (15/76) had multiple etiologies (two or more simultaneous causes). 26% (20/76) of the patients developed late leukocytosis without obvious cause. There was no statistical difference in ICU stay (hours) 163+285 (4-1152) vs 63+90 (4-1152); hospital stay (days) 25+29 (4-156) vs 13+5 (5-18); 1-month survival 99% vs 100%; 3-months survival 95% vs 86%; and 1-year survival 78% vs 86% in patients with or without leukocytosis.
CONCLUSION: Leukocytosis is a common finding post LT (92%). The most common causes of leukocytosis were: combined etiologies, stress induced, infection, ischemia reperfusion injury and acute rejection in order of frequency. Twenty-six percent of patients had no definable etiology for leukocytosis. Clinical outcomes were not different among patients with or without leukocytosis.
CLINICAL IMPLICATIONS: 1/4 of LT recipients can be expected to have leukocytosis without specific clinical cause, and without clinical consequence.
DISCLOSURE: Carla Venegas, None.