Abstract
Lung transplantation has evolved into a life-saving therapy for select patients with end-stage lung diseases. However, long-term survival remains limited because of bronchiolitis obliterans syndrome (BOS). Soluble HLA-G, a mediator of adaptive immunity that modulates regulatory T cells and certain classes of effector T cells, may be a useful marker of survival free of BOS. We conducted a retrospective, single-center, pilot review of 38 lung transplant recipients who underwent collection of serum and bronchoalveolar lavage fluid 3, 6 and 12 months after transplantation, and compared soluble HLA-G concentrations in each to the presence of type A rejection and lymphocytic bronchiolitis in the first 12 months and to the presence of BOS at 24 months after transplantation. Lung soluble HLA-G concentrations were directly related to the presence of type A rejection but not to lymphocytic bronchiolitis. Our data demonstrate that soluble HLA-G concentrations in bronchoalveolar lavage but not in serum correlates with the number of acute rejection episodes in the first 12 months after lung transplantation, and thus may be a reactive marker of rejection.
Highlights
Lung transplantation (LT) remains the best hope for selected patients with end-stage lung diseases
We examined a respective cohort of LT recipients to compare the presence of sHLA-G in plasma and in bronchoalveolar lavage (BAL) fluid collected in the first year to the number of acute rejection episodes in the first year and the appearance of bronchiolitis obliterans syndrome (BOS) after transplantation
Bronchiolitis obliterans syndrome remains the major limitation to long-term survival after lung transplantation despite advances in immunosuppressive therapy, infection control, and management of other complications
Summary
Lung transplantation (LT) remains the best hope for selected patients with end-stage lung diseases. Clinically manifested as bronchiolitis obliterans syndrome (BOS), remains a major limitation to long-term survival: BOS occurs in 40–60% of lung transplant recipients within 4 years and is the leading cause of death after the first year, despite advances in the use of immunosuppressive therapy [1]. HLA-G is a major histocompatibility complex class I antigen encoded by a gene on chromosome 6p21 [4]. Perhaps more important for long-term tolerance, HLA-G-bearing antigen-presenting cells induce the differentiation of CD4+ T cells into suppressor cells [12,13]
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