The relationship between myocardial fibrosis and plasma level of galectin-3 in heart transplant recipients underwent acute rejection
Olga P. Shevchenko1,2, Olga E. Gichkun1,2, Natalia P. Mozheiko1, Adelia A. Ulybysheva1, Ekaterina A. Stakhanova1, Julia A. Kachanova1, Alex O. Shevchenko1,2.
1V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs , Moscow, Russian Federation; 2I.M. Sechenov First Moscow State Medical University , Moscow, Russian Federation
Background: Fibrosis is directly linked to cardiac dysfunction and risk of graft loss in heart recipients. One of the investigating biomarkers of severity of heart failure and myocardial fibrosis is galectin-3.
Objective: to evaluate the relationship and diagnostic value of galectin -3 in myocardial fibrosis in heart recipients underwent acute rejection or not.
Patients and Methods: 124 patients (pts.) aged 16 to 71 (48 ± 13) years who received a heart transplant (HTx) between January 2013 and September 2016 in Shumakov National Research Centre of Transplantology (Moscow). Fibrosis, acute cellular and humoral rejections were verified by endomyocardial biopsies (EMB). Plasma galectin-3 (gal-3) concentration was measured by ELISA.
Results: A month after HTx, the plasma level of gal-3 was significantly higher than in pts. before HTx (29.2 and 15.92 ng/ml, p <0.05). In one year and later after HTx the level of gal-3 decreased and did not significantly differ from the level before HTx. In one month after HTx there were no significant differences in the median concentrations of gal-3 in patients who underwent (acute cellular, n = 27 and humoral, n = 1) and did not suffer (n = 18) rejection episodes (31.56 and 27,45 ng/ml, respectively) and in the groups with and without fibrosis (30.55 and 26.39 ng / ml, respectively, p = 0.86). One year and later after HTx significant differences were revealed in patients without rejection (n = 32, median - 15.25 ng / ml) and patients undergoing acute transplant rejection episodes (n = 75, median - 19.20 ng / ml, p = 0.00) and level of gal-3 was significantly higher in pts. with myocardial fibrosis compared without it (p = 0.00).The level of gal-3 was higher the threshold value (≥16.9 ng/ml) in 49 recipients underwent acute rejection episodes, of which 44 (90%) was verified myocardial fibrosis. Galectin-3 was lower threshold value (≤16.9 ng/ml) in 33 recipients who underwent acute rejection episode, of which 18 (54%) was identified myocardial fibrosis. In recipients, underwent acute graft rejection episodes, a galectin-3 level above a threshold value (≥16.9 ng/ml), the risk of developing graft myocardial fibrosis is higher [RR=1.64 ± 0.1 95%, CI 1.1–2.2] than in recipients with a galectin-3 level lower threshold value.
Conclusions: At the long term period after transplantation in heart transplant recipients who underwent acute rejection, plasma levels of gal-3 above 16.9 ng/ml are associated with a higher risk of myocardial fibrosis compared to recipients with a gal-3 level below the threshold value.
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