Abstract

Purpose: Galectin-3 has been associated with renal fibrosis and decline of renal function. We aimed to determine the association of galectin-3 with long-term risk of death-censored graft failure in a large cohort of extensively phenotyped renal transplant recipients (RTR). Methods: We performed a longitudinal cohort study in 561 RTR with a functioning graft ≥1 year, recruited between 2001 and 2003 in a university setting. Galectin-3 levels were determined in serum samples (BG Medicine, Inc, Waltham, MA). Death-censored graft failure was defined as restart of dialysis or re-transplantation. Cox-proportional hazards regression analyses were performed to assess the association of galectin-3 with outcome. Results: Baseline median galectin-3 was 21.1 [interquartile range, 17.0‒27.2] ng/mL. During a median follow-up of 6.9 [6.2-7.5] years, 53 RTR developed graft failure. In multivariable-adjusted Cox regression analysis, galectin-3 was associated with death-censored graft failure (hazard ratio, 2.32 per 1-SD increase; 95% confidence interval, 1.68 to 3.20, P<0.001), independent of well-established general and renal transplant-specific risk factors, including estimated Glomerular Filtration Rate and proteinuria. Conclusions: In RTR, galectin-3 is elevated and independently associated with long-term risk of death-censored graft failure. Galectin-3 may be helpful to assess prognosis and guide existing therapy. Whether a novel galectin-3-targeted therapy may represent an opportunity to decrease the burden of long-term graft failure in stable RTR requires further studies.