Preoperative plasma club (Clara) cell secretory protein levels are associated with primary graft dysfunction after lung transplantation

R. J. Shah, N. Wickersham, D. J. Lederer, S. M. Palmer, E. Cantu, J. M. Diamond, S. M. Kawut, V. N. Lama, S. Bhorade, M. Crespo, E. Demissie, J. Sonett, K. Wille, J. Orens, A. Weinacker, P. Shah, S. Arcasoy, D. S. Wilkes, J. D. Christie, L. B. Ware

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Abstract

Inherent recipient factors, including pretransplant diagnosis, obesity and elevated pulmonary pressures, are established primary graft dysfunction (PGD) risks. We evaluated the relationship between preoperative lung injury biomarkers and PGD to gain further mechanistic insight in recipients. We performed a prospective cohort study of recipients in the Lung Transplant Outcomes Group enrolled between 2002 and 2010. Our primary outcome was Grade 3 PGD on Day 2 or 3. We measured preoperative plasma levels of five biomarkers (CC-16, sRAGE, ICAM-1, IL-8 and Protein C) that were previously associated with PGD when measured at the postoperative time point. We used multivariable logistic regression to adjust for potential confounders. Of 714 subjects, 130 (18%) developed PGD. Median CC-16 levels were elevated in subjects with PGD (10.1 vs. 6.0, p < 0.001). CC-16 was associated with PGD in nonidiopathic pulmonary fibrosis (non-IPF) subjects (OR for highest quartile of CC-16: 2.87, 95% CI: 1.37, 6.00, p = 0.005) but not in subjects with IPF (OR 1.38, 95% CI: 0.43, 4.45, p = 0.59). After adjustment, preoperative CC-16 levels remained associated with PGD (OR: 3.03, 95% CI: 1.26, 7.30, p = 0.013) in non-IPF subjects. Our study suggests the importance of preexisting airway epithelial injury in PGD. Markers of airway epithelial injury may be helpful in pretransplant risk stratification in specific recipients. The authors demonstrate a relationship between perioperative CC-16 blood levels and an increased risk of primary lung allograft dysfunction, particularly in those without idiopathic pulmonary fibrosis as a pretransplant diagnosis.

Original languageEnglish
Pages (from-to)446-452
Number of pages7
JournalAmerican Journal of Transplantation
Volume14
Issue number2
DOIs
StatePublished - Feb 2014

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Primary Graft Dysfunction
Uteroglobin
Lung Transplantation
Pulmonary Fibrosis
Lung
Biomarkers
Idiopathic Pulmonary Fibrosis
Wounds and Injuries
Lung Injury
Intercellular Adhesion Molecule-1
Protein C
Interleukin-8
Allografts
Cohort Studies
Obesity
Logistic Models

Keywords

  • Acute lung injury
  • biomarkers
  • CC-16
  • lung transplantation
  • primary graft dysfunction

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)
  • Medicine(all)

Cite this

Preoperative plasma club (Clara) cell secretory protein levels are associated with primary graft dysfunction after lung transplantation. / Shah, R. J.; Wickersham, N.; Lederer, D. J.; Palmer, S. M.; Cantu, E.; Diamond, J. M.; Kawut, S. M.; Lama, V. N.; Bhorade, S.; Crespo, M.; Demissie, E.; Sonett, J.; Wille, K.; Orens, J.; Weinacker, A.; Shah, P.; Arcasoy, S.; Wilkes, D. S.; Christie, J. D.; Ware, L. B.

In: American Journal of Transplantation, Vol. 14, No. 2, 02.2014, p. 446-452.

Research output: Contribution to journalArticle

Shah, RJ, Wickersham, N, Lederer, DJ, Palmer, SM, Cantu, E, Diamond, JM, Kawut, SM, Lama, VN, Bhorade, S, Crespo, M, Demissie, E, Sonett, J, Wille, K, Orens, J, Weinacker, A, Shah, P, Arcasoy, S, Wilkes, DS, Christie, JD & Ware, LB 2014, 'Preoperative plasma club (Clara) cell secretory protein levels are associated with primary graft dysfunction after lung transplantation', American Journal of Transplantation, vol. 14, no. 2, pp. 446-452. https://doi.org/10.1111/ajt.12541
Shah, R. J. ; Wickersham, N. ; Lederer, D. J. ; Palmer, S. M. ; Cantu, E. ; Diamond, J. M. ; Kawut, S. M. ; Lama, V. N. ; Bhorade, S. ; Crespo, M. ; Demissie, E. ; Sonett, J. ; Wille, K. ; Orens, J. ; Weinacker, A. ; Shah, P. ; Arcasoy, S. ; Wilkes, D. S. ; Christie, J. D. ; Ware, L. B. / Preoperative plasma club (Clara) cell secretory protein levels are associated with primary graft dysfunction after lung transplantation. In: American Journal of Transplantation. 2014 ; Vol. 14, No. 2. pp. 446-452.
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