title: Mannose binding lectin gene polymorphisms confer a major risk for severe infections after liver transplantation.
abstract: OBJECTIVE
  Infection is the primary cause of death after liver transplantation. Mannose binding lectin (MBL) is a recognition molecule of the lectin pathway of complement and a key component of innate immunity. MBL variant alleles have been described in the coding region of the MBL gene, which are associated with low MBL serum concentration and impaired MBL structure and function. The aims of our study were to establish the role of the liver in production of serum MBL and to evaluate the effect of MBL variant alleles on the susceptibility to infection after liver transplantation.
  
  
  METHODS
  We investigated 49 patients undergoing orthotopic liver transplantation. MBL exon 1 and promoter polymorphisms were determined in patients and in liver donors. MBL serum concentration was determined before and during 1 year after transplantation. The incidence of clinically significant infections during this period was assessed.
  
  
  RESULTS
  Transplantation of MBL wildtype recipients with donor livers carrying MBL variant alleles resulted in a rapid and pronounced decrease of serum MBL levels. This serum conversion was associated with the disappearance of high molecular weight MBL. No indication for extrahepatic production of serum MBL could be obtained. The presence of MBL variant alleles in the MBL gene of the donor liver, but not in the recipient, was associated with a strongly increased incidence of clinically significant infections after transplantation.
  
  
  CONCLUSIONS
  Serum MBL is produced by the liver under strong genetic control. After liver transplantation, the MBL genotype of the donor liver is a major risk determinant for life-threatening infections.
authors.affiliation: Department of Surgery, Leiden University Medical Center, The Netherlands. l.h.bouwman@lumc.nl
authors.forename: Lee H
authors.initials: LH
authors.lastname: Bouwman
authors.forename: Anja
authors.initials: A
authors.lastname: Roos
authors.forename: Onno T
authors.initials: OT
authors.lastname: Terpstra
authors.forename: Peter
authors.initials: P
authors.lastname: de Knijff
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.forename: Hein W
authors.initials: HW
authors.lastname: Verspaget
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Berger
authors.forename: Mohamed R
authors.initials: MR
authors.lastname: Daha
authors.forename: Marijke
authors.initials: M
authors.lastname: Frölich
authors.forename: Arno R
authors.initials: AR
authors.lastname: van der Slik
authors.forename: Ilias I
authors.initials: II
authors.lastname: Doxiadis
authors.forename: Bart O
authors.initials: BO
authors.lastname: Roep
authors.forename: Alexander F M
authors.initials: AF
authors.lastname: Schaapherder
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology / Q000235:genetics*; D001483:Base Sequence; D015153:Blotting, Western; D015331:Cohort Studies; D005260:Female; D005786:Gene Expression Regulation; D005819:Genetic Markers; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D037601:Mannose-Binding Lectin / Q000235:genetics / Q000378:metabolism*; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate
chemical_list: D005819:Genetic Markers; D037601:Mannose-Binding Lectin