Use of serum KL-6 level for detecting patients with restrictive allograft syndrome after lung transplantation

PLoS One. 2020 Jan 13;15(1):e0226488. doi: 10.1371/journal.pone.0226488. eCollection 2020.

Abstract

KL-6 is an antigen produced mainly by damaged type II pneumocytes that is involved in interstitial lung disease. Chronic lung allograft dysfunction (CLAD) after lung transplantation (LT) is a major concern for LT clinicians, especially in patients with restrictive allograft syndrome (RAS). We investigated KL-6 levels in serum and bronchoalveolar lavage fluid (BALF) as a potential biomarker of the RAS phenotype. Levels of KL-6 in serum and BALF were measured in 73 bilateral LT recipients, and patients were categorized into 4 groups: stable (ST), infection (LTI), bronchiolitis obliterans syndrome (BOS), and RAS. We also studied a healthy cohort to determine reference values for serum KL-6. The highest levels of KL-6 were found in the serum of patients with RAS (918 [487.8-1638] U/mL). No differences were found for levels of KL-6 in BALF. Using a cut-off value of 465 U/mL serum KL-6 levels was able to differentiate RAS patients from BOS patients with a sensitivity of 100% and a specificity of 75%. Furthermore, higher serum KL-6 levels were associated with a decline in Forced Vital Capacity (FVC) at 6 months after sample collection. Therefore, KL-6 in serum may well be a potential biomarker for differentiating between the BOS and RAS phenotypes of CLAD in LT recipients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Area Under Curve
  • Biomarkers / blood
  • Bronchiolitis Obliterans / diagnosis
  • Bronchiolitis Obliterans / etiology
  • Bronchoalveolar Lavage Fluid / chemistry
  • Female
  • Humans
  • Lung Diseases / therapy
  • Lung Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Mucin-1 / analysis
  • Mucin-1 / blood*
  • Phenotype
  • Primary Graft Dysfunction / diagnosis
  • Primary Graft Dysfunction / etiology*
  • ROC Curve
  • Sensitivity and Specificity
  • Transplantation, Homologous
  • Vital Capacity
  • Young Adult

Substances

  • Biomarkers
  • MUC1 protein, human
  • Mucin-1

Grants and funding

This project was supported by the Sociedad Española de Neumología y Cirugía Torácica (SEPAR [Spanish Society of Pulmonology and Thoracic Surgery]; PI172/2013). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.