title: Effect of single vs bilateral lung transplantation on plasma surfactant protein D levels in idiopathic pulmonary fibrosis.
abstract: BACKGROUND
  Serum levels of surfactant protein D (SP-D) have been suggested as reflecting epithelial damage in acute lung injury, COPD, and idiopathic pulmonary fibrosis (IPF). However, little is known about SP-D levels in the setting of lung transplantation.
  
  
  METHODS
  We examined plasma SP-D levels in 104 subjects from a prospective, multicenter cohort study of lung allograft recipients. Plasma SP-D was measured by enzyme-linked immunosorbent assay prior to transplant and daily for 3 days after transplant.
  
  
  RESULTS
  Subjects undergoing transplant for IPF had higher baseline SP-D levels (median, 325 ng/mL) compared with subjects with cystic fibrosis, COPD, and pulmonary hypertension (median, 100, 80, and 82 ng/mL, respectively; P = .0001). Among subjects with IPF undergoing bilateral transplant, SP-D levels declined rapidly postoperatively. In contrast, SP-D levels in subjects undergoing single lung transplant for IPF remained significantly higher than those of bilateral allograft recipients. Among subjects undergoing single lung transplant for IPF, the development of primary graft dysfunction (PGD) was associated with a subsequent rise in SP-D levels, whereas SP-D levels in IPF subjects undergoing bilateral transplant declined, even in the presence of grade 3 PGD. Importantly, single lung allograft recipients without PGD had higher postoperative SP-D levels than bilateral allograft recipients with PGD.
  
  
  CONCLUSIONS
  Subjects undergoing lung transplant for IPF have significantly higher baseline plasma SP-D levels compared with those with other diagnoses. Plasma SP-D is likely a biomarker of the air-blood barrier integrity in the native IPF lung, but may be less useful as a biomarker of PGD after transplant.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA. Electronic address: michael.sims@uphs.upenn.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Sims
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Beers
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Ahya
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.affiliation: Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Sims
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York City, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Ann Arbor, MI.
authors.forename: Keith
authors.initials: K
authors.lastname: Wille
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Vibha N
authors.initials: VN
authors.lastname: Lama
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville TN.
authors.forename: Pali D
authors.initials: PD
authors.lastname: Shah
authors.affiliation: Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Orens
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Chicago Medical Center, Chicago, IL.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Bhorade
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Ann
authors.initials: A
authors.lastname: Weinacker
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Ejigayehu
authors.initials: E
authors.lastname: Demissie
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Scarlett
authors.initials: S
authors.lastname: Bellamy
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville TN.
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003550:Cystic Fibrosis / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood; D054990:Idiopathic Pulmonary Fibrosis / Q000097:blood / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000097:blood / Q000175:diagnosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood; D037663:Pulmonary Surfactant-Associated Protein D / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D037663:Pulmonary Surfactant-Associated Protein D