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Original Research: TRANSPLANTATION |

Effect of Single vs Bilateral Lung Transplantation on Plasma Surfactant Protein D Levels in Idiopathic Pulmonary FibrosisSurfactant Protein D and Lung Transplantation

Michael W. Sims, MD; Michael F. Beers, MD; Vivek N. Ahya, MD; Steven M. Kawut, MD, FCCP; Karen D. Sims, MD, PhD; David J. Lederer, MD, FCCP; Scott M. Palmer, MD, MHS, FCCP; Keith Wille, MD; Vibha N. Lama, MD; Pali D. Shah, MD; Jonathan B. Orens, MD, FCCP; Sangeeta Bhorade, MD, FCCP; Maria Crespo, MD; Ann Weinacker, MD, FCCP; Ejigayehu Demissie, MSN; Scarlett Bellamy, ScD; Jason D. Christie, MD, FCCP; Lorraine B. Ware, MD, FCCP; for the Lung Transplant Outcomes Group
Author and Funding Information

From the Division of Pulmonary, Allergy, and Critical Care Medicine (Drs M. W. Sims, Beers, Ahya, Kawut, and Christie), the Department of Biostatistics and Epidemiology (Drs Kawut, Bellamy, and Christie and Ms Demissie), and the Division of Infectious Diseases (Dr K. D. Sims), University of Pennsylvania School of Medicine, Philadelphia, PA; the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Lederer), Columbia University College of Physicians and Surgeons, New York City, NY; the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Palmer), Duke University School of Medicine, Durham, NC; the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Wille), University of Alabama at Birmingham; the Division of Pulmonary and Critical Care Medicine (Dr Lama), University of Michigan Health System, Ann Arbor, MI; the Division of Allergy, Pulmonary, and Critical Care Medicine (Drs Shah and Ware), Vanderbilt University School of Medicine, Nashville TN; the Division of Pulmonary and Critical Care Medicine (Dr Orens), The Johns Hopkins University School of Medicine, Baltimore, MD; the Division of Pulmonary and Critical Care Medicine (Dr Bhorade), University of Chicago Medical Center, Chicago, IL; the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Crespo), University of Pittsburgh Medical Center, Pittsburgh, PA; and the Division of Pulmonary and Critical Care Medicine (Dr Weinacker), Stanford University School of Medicine, Stanford, CA.

Correspondence to: Michael W. Sims, MD, MSCE, 4th Floor Mutch Bldg, Penn Presbyterian Medical Center, 51 N 39th St, Philadelphia, PA 19104; e-mail: michael.sims@uphs.upenn.edu


Funding/Support: This work was supported by the National Institutes of Health [Grants HL093303, HL081332, HL088263, HL081619, and HL087115].

A complete list of study participants is located in e-Appendix 1.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):489-496. doi:10.1378/chest.10-2065
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Background:  Serum levels of surfactant protein D (SP-D) have been suggested as reflecting epithelial damage in acute lung injury, COPD, and idiopathic pulmonary fibrosis (IPF). However, little is known about SP-D levels in the setting of lung transplantation.

Methods:  We examined plasma SP-D levels in 104 subjects from a prospective, multicenter cohort study of lung allograft recipients. Plasma SP-D was measured by enzyme-linked immunosorbent assay prior to transplant and daily for 3 days after transplant.

Results:  Subjects undergoing transplant for IPF had higher baseline SP-D levels (median, 325 ng/mL) compared with subjects with cystic fibrosis, COPD, and pulmonary hypertension (median, 100, 80, and 82 ng/mL, respectively; P = .0001). Among subjects with IPF undergoing bilateral transplant, SP-D levels declined rapidly postoperatively. In contrast, SP-D levels in subjects undergoing single lung transplant for IPF remained significantly higher than those of bilateral allograft recipients. Among subjects undergoing single lung transplant for IPF, the development of primary graft dysfunction (PGD) was associated with a subsequent rise in SP-D levels, whereas SP-D levels in IPF subjects undergoing bilateral transplant declined, even in the presence of grade 3 PGD. Importantly, single lung allograft recipients without PGD had higher postoperative SP-D levels than bilateral allograft recipients with PGD.

Conclusions:  Subjects undergoing lung transplant for IPF have significantly higher baseline plasma SP-D levels compared with those with other diagnoses. Plasma SP-D is likely a biomarker of the air-blood barrier integrity in the native IPF lung, but may be less useful as a biomarker of PGD after transplant.

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