*Purpose: An increased demand for liver transplantation (LT) prevails. Galectin-3 is a lectin implicated in inflammation, immunoregulation, and liver fibrosis. In this study we assessed if galectin-3 levels at the time of transplant discriminate patients with advanced cirrhosis and predict post-transplant complications.

*Methods: Sera and liver samples were collected from patients with cirrhosis undergoing LT and from an external cohort of patients with alcoholic liver disease including alcoholic hepatitis (AH). Galectin-3 was analyzed by ELISA, real-time PCR, immunohistochemistry and RNA seq. ROC curves and logistic regression were performed to assess the predictive power of galectin-3 for disease severity and posttransplant infections.

*Results: Increased circulating and hepatic galectin-3 levels were found in advanced cirrhosis vs. compensated cirrhosis and controls (Fig.1A). Galectin-3 significantly correlated with the MELD-Na score and with disease severity parameters and had significant discriminating power for compensated and advanced cirrhosis (Fig.1B). Patients with advanced cirrhosis had important intrahepatic inflammation, with elevation of IL-6, MCP-1, IL-8 and M-CSF, which strongly correlated with galectin-3. Moreover, RNAseq showed higher galectin-3 in severe vs. early AH, correlated with genes reflecting intrahepatic inflammation, and significantly discriminated severe AH. Importantly, circulating galectin-3 was a predictor of early post-transplant infections and was higher in patients with pretransplant systemic inflammatory response syndrome (Fig.1C).

*Conclusions: Galectin-3 is a novel biomarker of active intrahepatic inflammation that discriminates advanced cirrhosis including severe AH and predicts a higher risk of posttransplant infectious complications.

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