Early epithelial injury after lung transplantation may contribute to development of bronchiolitis obliterans syndrome (BOS). We evaluated the relationship between early post-operative soluble receptor for advanced glycation end product (sRAGE) levels, a marker of type I alveolar cell injury, and BOS. We performed a cohort study of 106 lung transplant recipients between 2002 and 2006 at the University of Pennsylvania with follow-up through 2010. Plasma sRAGE was measured 6 and 24 hours after transplantation. Cox proportional hazards models were used to evaluate the association between sRAGE and time to BOS, defined according to ISHLT guidelines. Sixty (57%) subjects developed BOS. The average time to BOS was 3.4 years. sRAGE levels measured at 6 hours (HR per SD of sRAGE: 1.69, 95% CI: 1.11, 2.57, p=0.02) and 24 hours (HR per SD of sRAGE: 1.74, 95% CI: 1.14, 2.65, p=0.01) were associated with an increased hazard of BOS. Multivariable Cox regression indicated this relationship was independent of potential confounders. Elevated plasma sRAGE levels measured in the immediate post-operative period are associated with the development of BOS. Early epithelial injury after transplantation may contribute to the development of fibrosis in BOS.
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