title: Pretransplant serum human chitinase-like glycoprotein YKL-40 concentrations independently predict bronchiolitis obliterans development in lung transplant recipients.
abstract: OBJECTIVE
  Bronchiolitis obliterans syndrome (BOS) is the main long-term complication limiting survival after lung transplantation. There exists no cure for BOS and its mechanisms are not well understood. Early identification of BOS could therefore contribute to improvement of therapeutic and preventive measures. The human chitinase-like glycoprotein YKL-40 is involved in regulation of inflammatory tissue response and remodeling and is associated with pulmonary fibrosis. However, its role in BOS is unknown.
  
  
  METHODS
  A total of 57 recipients with irreversible fibrotic BOS and matched 85 recipients without BOS were retrospectively analyzed. Pretransplant serum samples were available at the time of the study. Serum and bronchoalveolar lavage samples were obtained at BOS diagnosis or at a comparable time point in patients without BOS. Additionally, serum samples were obtained 3 months later after BOS diagnosis or after the first sample in patients without BOS. YKL-40 concentrations were analyzed by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Pretransplant serum YKL-40 concentrations were higher in recipients who developed BOS and were useful in identifying patients at high risk for BOS development (odds ratio, 1.3; 95% confidence interval, 1.01-1.9; P = .02). At BOS diagnosis, posttransplant YKL-40 concentrations were significantly elevated in the serum and bronchoalveolar lavage of patients with BOS compared with those without BOS at a comparable posttransplant time point. Of note, there was no significant association between serum YKL-40 concentrations and the frequency of acute rejection episodes.
  
  
  CONCLUSIONS
  Elevated pretransplant serum YKL-40 concentration is associated with BOS development and could be an independent biomarker in early prediction and monitoring of BOS.
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Jaksch
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria; Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria. Electronic address: mohamed.salama@meduniwien.ac.at.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Salama
mesh_terms: D054392:Adipokines / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001989:Bronchiolitis Obliterans / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D016009:Chi-Square Distribution; D000071451:Chitinase-3-Like Protein 1; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D037102:Lectins / Q000097:blood*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D054392:Adipokines; D015415:Biomarkers; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; D037102:Lectins