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A novel method for the diagnosis of lung transplant rejection
  1. R Agarwal
  1. Senior Resident, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India;

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The most common causes of morbidity and mortality following lung transplantation are primary graft failure, infection, and acute and chronic rejection. Clinical criteria alone are inaccurate for the diagnosis of graft rejection. The diagnosis can be made by transbronchial biopsy but this procedure is invasive and cannot be performed repeatedly. Hepatocyte growth factor (HGF) is a glycoprotein highly expressed in the lung parenchyma and produced after acute lung injury. This study was designed to assess whether serum HGF could act as a marker of acute rejection following lung transplantation.

The authors measured serum concentrations of HGF by ELISA in 109 patients undergoing lung transplantation (65 with chronic obstructive pulmonary disease, 23 with cystic fibrosis, and 21 with idiopathic pulmonary fibrosis) and 12 healthy controls. The mean serum HGF concentration before transplantation was higher in the patients than in the controls, and postoperatively rose significantly on the first day before decreasing by day 3. At an episode of acute rejection the serum HGF concentration was significantly higher than in all other groups (controls, patients before transplantation, patients with no rejection, and patients with infection). Logistic regression analysis identified the serum HGF concentration as an independent predictor of lung graft rejection (p = 0.012). After steroid treatment HGF concentrations returned to the preoperative value within 3 days.

The authors conclude that, since serum concentrations of HGF increase with graft rejection but not infection and the values decline with steroid treatment, serum HGF monitoring could be a sensitive predictor of lung graft rejection.

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