394. Mannose Binding Lectin and Adverse Outcomes after Liver Transplant
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Mannose binding lectin (MBL) is a liver derived serum lectin and a recognition molecule of the lectin pathway of complement activation. Both high and low levels of MBL are associated with several diseases including infections in vulnerable populations. About 10-40% Caucasians are MBL deficient (level <500 ng/ml). Infection is an important adverse outcome after liver transplant (LT) and a risk factor for mortality and rejection.
Objective: To study the association of donor MBL level (dMBL) and recipient MBL level (rMBL) with risk of significant adverse outcomes after LT - infections [cytomegalovirus (CMV) disease, invasive fungal infection (IFI) and bacteremia], rejection and mortality.
Methods: This is a retrospective cohort study using data from a prior multi-center randomized controlled trial evaluating the efficacy of CMV immunoglobulin prophylaxis in 146 LT recipients. Definitions for outcomes were previously described in the trial. dMBL and rMBL were measured on stored pre LT donor (71) and recipient (96) serum using quantitative ELISA (R&D). ELISA on the remaining samples is ongoing.
Results: On preliminary analysis 12 out of 71 donors (17%) and 14 out of 96 recipients (15%) had MBL levels <500 ng/ml. Median dMBL was 1294 ng/ml and rMBL was 1376 ng/ml. Median dMBL for patients with CMV disease was higher than those without CMV disease (p=0.03). Median dMBL was higher for patients with IFI and lower for patients with rejection, with a trend toward significance. No significant difference was seen in the median rMBL level between groups.
Number of patients
(n =71)
Median donor MBL level
(ng/ml)
p value*
CMV disease +
CMV disease -
14
57
1538
995
0.03
Invasive fungal infection +
Invasive fungal infection -
13
58
1613
1197
0.06
Bacteremia +
Bacteremia -
18
53
1268
1294
0.66
Rejection +
Rejection -
50
21
1165
1499
0.09
Mortality at 1 year +
Mortality at 1 year -
18
53
1115
1299
0.53
Mortality at 5 year +
Mortality at 5 year -
30
41
1413
1178
0.19
* Mann Whitney test
Conclusions: Our preliminary findings suggest that median dMBL was higher in patients with CMV disease than those without CMV disease.
Roberta O'Connor, PhD1, Swetal Patel, MD1, Robin Ruthazer, MPH1, David Snydman, MD, FIDSA2, Honorine Ward, MD1 and  S. R. Patel, None..
H. D. Ward, None..
R. O'Connor, None..
R. Ruthazer, None..
D. Snydman, None., (1)Tufts Medical Center, Boston, MA, (2)Tufts New England Medical Center, Boston, MA