title: Plasma levels of receptor for advanced glycation end products, blood transfusion, and risk of primary graft dysfunction.
abstract: BACKGROUND
  The receptor for advanced glycation end products (RAGE) is an important marker of lung epithelial injury and may be associated with impaired alveolar fluid clearance. We hypothesized that patients with primary graft dysfunction (PGD) after lung transplantation would have higher RAGE levels in plasma than patients without PGD.
  
  
  OBJECTIVE
  To test the association of soluble RAGE (sRAGE) levels with PGD in a prospective, multicenter cohort study.
  
  
  METHODS
  We measured plasma levels of sRAGE at 6 and 24 hours after allograft reperfusion in 317 lung transplant recipients at seven centers. The primary outcome was grade 3 PGD (Pa(O(2))/Fi(O(2)) < 200 with alveolar infiltrates) within the first 72 hours after transplantation.
  
  
  RESULTS
  Patients who developed PGD had higher levels of sRAGE than patients without PGD at both 6 hours (median 9.3 ng/ml vs. 7.5 ng/ml, respectively; P = 0.028) and at 24 hours post-transplantation (median 4.3 ng/ml vs. 1.9 ng/ml, respectively; P < 0.001). Multivariable logistic regression analyses indicated that the relationship between levels of sRAGE and PGD was attenuated by elevated right heart pressures and by the use of cardiopulmonary bypass. Median sRAGE levels were higher in subjects with cardiopulmonary bypass at both 6 hours (P = 0.003) and 24 hours (P < 0.001). sRAGE levels at 6 hours were significantly associated with intraoperative red cell transfusion (Spearman's rho = 0.39, P = 0.002 in those with PGD), and in multivariable linear regression analyses this association was independent of confounding variables (P = 0.02).
  
  
  CONCLUSIONS
  Elevated plasma levels of sRAGE are associated with PGD after lung transplantation. Furthermore, plasma sRAGE levels are associated with blood product transfusion and use of cardiopulmonary bypass.
authors: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. jchristi@mail.med.upenn.edu
authors: Jason D
authors: JD
authors: Christie
authors: Chirag V
authors: CV
authors: Shah
authors: Steven M
authors: SM
authors: Kawut
authors: Nilam
authors: N
authors: Mangalmurti
authors: David J
authors: DJ
authors: Lederer
authors: Joshua R
authors: JR
authors: Sonett
authors: Vivek N
authors: VN
authors: Ahya
authors: Scott M
authors: SM
authors: Palmer
authors: Keith
authors: K
authors: Wille
authors: Vibha
authors: V
authors: Lama
authors: Pali D
authors: PD
authors: Shah
authors: Ashish
authors: A
authors: Shah
authors: Ann
authors: A
authors: Weinacker
authors: Clifford S
authors: CS
authors: Deutschman
authors: Benjamin A
authors: BA
authors: Kohl
authors: Ejigayehu
authors: E
authors: Demissie
authors: Scarlett
authors: S
authors: Bellamy
authors: Lorraine B
authors: LB
authors: Ware
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016913:Blood Component Transfusion; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000097:blood*; D011446:Prospective Studies; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000097:blood*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic