*Purpose: Galectin-3 (Gal3) is a beta-galactoside binding lectin that plays a key role in inflammation and immune response. Studies on Gal3 in liver transplantation are limited. The aim of this study was to investigate the association between circulating Gal3 levels and post-liver transplant acute rejection.

*Methods: Citrated plasma was collected from recipients at time of transplant. Gal3 was measured using standard ELISA. The primary outcome of interest was biopsy-proven acute cellular rejection (ACR) within 30 days of transplant. Continuous data is presented as mean (standard deviation) and compared using two-tailed t-test. Logistic regression was used to evaluate for an association between Gal3 and rejection. ROC curves were used to assess the predictive power of Gal-3 for ACR.

*Results: Plasma was collected from 41 recipients. 7 (17%) recipients had 30-day ACR (Table 1). Recipients with ACR had significantly higher Gal3 levels at time of transplant (17.91 ± 9.39 vs. 12.39 ± 4.20 ng/ml, p = 0.02, Figure 1). There was a significant association between transplant Gal3 and 30-day ACR (OR 1.18, 95% CI 1.09 – 1.38, p = 0.04). A transplant Gal3 level > 17.29 ng/ml was significantly predictive of 30-day ACR (OR 13.78, 95% CI 2.04 – 92.97, AUC = 0.74, p = 0.007).

*Conclusions: Gal3 is a useful biomarker that can be used at time of transplant to predict early acute rejection. Recipient risk stratification based on Gal3 plasma levels can guide clinical decisions regarding immunosuppression regimen and surveillance labs and biopsies.

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