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Todd JL, Weber JM, Kelly FL, Neely ML, Nagler A, Carmack D, Frankel CW, Brass DM, Belperio JA, Budev MM, Hartwig MG, Martinu T, Reynolds JM, Shah PD, Singer LG, Snyder LD, Weigt SS, Palmer SM. Early posttransplant reductions in club cell secretory protein associate with future risk for chronic allograft dysfunction in lung recipients: results from a multicenter study. J Heart Lung Transplant 2023; 42:741-749. [PMID: 36941179 DOI: 10.1016/j.healun.2023.02.1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Chronic lung allograft dysfunction (CLAD) increases morbidity and mortality for lung transplant recipients. Club cell secretory protein (CCSP), produced by airway club cells, is reduced in the bronchoalveolar lavage fluid (BALF) of lung recipients with CLAD. We sought to understand the relationship between BALF CCSP and early posttransplant allograft injury and determine if early posttransplant BALF CCSP reductions indicate later CLAD risk. METHODS We quantified CCSP and total protein in 1606 BALF samples collected over the first posttransplant year from 392 adult lung recipients at 5 centers. Generalized estimating equation models were used to examine the correlation of allograft histology or infection events with protein-normalized BALF CCSP. We performed multivariable Cox regression to determine the association between a time-dependent binary indicator of normalized BALF CCSP level below the median in the first posttransplant year and development of probable CLAD. RESULTS Normalized BALF CCSP concentrations were 19% to 48% lower among samples corresponding to histological allograft injury as compared with healthy samples. Patients who experienced any occurrence of a normalized BALF CCSP level below the median over the first posttransplant year had a significant increase in probable CLAD risk independent of other factors previously linked to CLAD (adjusted hazard ratio 1.95; p = 0.035). CONCLUSIONS We discovered a threshold for reduced BALF CCSP to discriminate future CLAD risk; supporting the utility of BALF CCSP as a tool for early posttransplant risk stratification. Additionally, our finding that low CCSP associates with future CLAD underscores a role for club cell injury in CLAD pathobiology.
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Affiliation(s)
- Jamie L Todd
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Jeremy M Weber
- Duke Clinical Research Institute, Durham, North Carolina
| | - Francine L Kelly
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Megan L Neely
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Andrew Nagler
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Dylan Carmack
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Courtney W Frankel
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - David M Brass
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - John A Belperio
- David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Matthew G Hartwig
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Tereza Martinu
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - John M Reynolds
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Pali D Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lianne G Singer
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Laurie D Snyder
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - S Sam Weigt
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Scott M Palmer
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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