title: Elevated plasma clara cell secretory protein concentration is associated with high-grade primary graft dysfunction.
abstract: Primary graft dysfunction (PGD) is the leading cause of early posttransplant morbidity and mortality after lung transplantation. Clara cell secretory protein (CC16) is produced by the nonciliated lung epithelium and may serve as a plasma marker of epithelial cell injury. We hypothesized that elevated levels of CC16 would be associated with increased odds of PGD. We performed a prospective cohort study of 104 lung transplant recipients. Median plasma CC16 levels were determined at three time points: pretransplant and 6 and 24 h posttransplant. The primary outcome was the development of grade 3 PGD within the first 72 h after transplantation. Multivariable logistic regression was performed to evaluate for confounding by donor and recipient demographics and surgical characteristics. Twenty-nine patients (28%) developed grade 3 PGD within the first 72 h. The median CC16 level 6 h after transplant was significantly higher in patients with PGD [13.8 ng/mL (IQR 7.9, 30.4 ng/mL)] than in patients without PGD [8.2 ng/mL (IQR 4.5, 19.1 ng/mL)], p = 0.02. Elevated CC16 levels were associated with increased odds of PGD after lung transplantation. Damage to airway epithelium or altered alveolar permeability as a result of lung ischemia and reperfusion may explain this association.
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. joshua.diamond@uphs.upenn.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Diamond
authors.forename: S M
authors.initials: SM
authors.lastname: Kawut
authors.forename: D J
authors.initials: DJ
authors.lastname: Lederer
authors.forename: V N
authors.initials: VN
authors.lastname: Ahya
authors.forename: B
authors.initials: B
authors.lastname: Kohl
authors.forename: J
authors.initials: J
authors.lastname: Sonett
authors.forename: S M
authors.initials: SM
authors.lastname: Palmer
authors.forename: M
authors.initials: M
authors.lastname: Crespo
authors.forename: K
authors.initials: K
authors.lastname: Wille
authors.forename: V N
authors.initials: VN
authors.lastname: Lama
authors.forename: P D
authors.initials: PD
authors.lastname: Shah
authors.forename: J
authors.initials: J
authors.lastname: Orens
authors.forename: S
authors.initials: S
authors.lastname: Bhorade
authors.forename: A
authors.initials: A
authors.lastname: Weinacker
authors.forename: E
authors.initials: E
authors.lastname: Demissie
authors.forename: S
authors.initials: S
authors.lastname: Bellamy
authors.forename: J D
authors.initials: JD
authors.lastname: Christie
authors.forename: L B
authors.initials: LB
authors.lastname: Ware
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000097:blood* / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D014598:Uteroglobin / Q000097:blood*
chemical_list: D015415:Biomarkers; C556389:SCGB1A1 protein, human; D014598:Uteroglobin