PURPOSE: Lipocalin-2 (Lcn-2) has been described as a marker and modulator of inflammation during ischemia/reperfusion injury (IRI) following solid organ transplantation. Aim of this study was to analyze Lcn-2 serum expression in the early phase after liver transplantation and to correlate its expression with acute rejection episodes, renal function and longterm graft survival.

MATERIALS AND METHODS: Sera of 68 patients undergoing orthotopic liver transplantation were collected perioperatively from days 0 to 15. Lcn-2 expression was analyzed by ELISA and correlated with clinical parameters of allograft rejection, dialysis and graft survival. Statistical analysis was carried out using Mann-Whitney U test, Wilcoxon test and Kaplan Maier analysis.

RESULTS: Lcn-2 serum levels were significantly higher in patients with poor renal function (n=23) at every single day of measurement (all pairwise p<0.031). A significant increase of Lcn-2 was seen in patients before diagnosis of acute rejection (70.2+/-18.7ng/ml on day -2 vs. 103.7+/-32,9ng/ml on day -1 vs. 155.0+/-44,7ng/ml on the day of rejection, p<0.046). An increase of Lcn-2 expression of more than the median of 115ng/ml during the observed period was associated with a worse 5-year graft survival compared to patients with an increase below (64,9% versus 85,3%) what was not statistically significant.

CONCLUSION: Herein we show that Lcn-2 is a marker which is upregulated prior to and during acute graft rejection that can be used for the early diagnosis of acute rejection in liver transplantation. Furthermore, its increase during the early posttransplant phase may predict the outcome in the long term.

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