Monitoring Inflammatory Markers and Anti-α-Gal Antibodies in Liver Transplant Recipients: Implications for Infection and Rejection

Objective: Living donor liver transplantation is a multifactorial process, and non-invasive serological parameters that may provide information about graft and patient status are still under investigation. However, time-dependent factors such as infection and rejection are often overlooked. Therefore, this study aimed to investigate anti-α-Gal1,3 levels and the expression of inflammatory and anti-inflammatory genes in peripheral blood samples obtained from 26 liver transplant patients before transplantation and at the first and sixth months post-transplantation. Additionally, 15 healthy volunteers were included as a control group, and patients were followed for two years to evaluate graft rejection. Method: A total of 26 living-donor liver transplant recipients and 15 healthy volunteers were included in the study. Peripheral blood samples were collected from patients before transplantation and at the first and sixth months after transplantation. Gene expression levels of IL2, IL4, IL6, IL10, TNF, IFNG, FOXP3, TREM1, CD14, and HLAG5 were analyzed by qRT-PCR, while anti-α-Gal IgM and IgG levels were measured by ELISA. In addition, biochemical parameters and microbiological culture analyses were evaluated, and bacterial identification was confirmed by MALDI-TOF MS when necessary. Analyses were performed across three time points with respect to infection status and graft rejection. Results: While the expression of IFNG, IL2, and HLAG5 significantly increased 6 months after transplantation, IL10 expression decreased significantly. In patients without rejection, IFNG expression increased significantly and IL10 expression decreased significantly at the sixth month. Microbiological evaluation showed that infections were more frequent, particularly during the first three months after transplantation. While anti-α-Gal IgG levels did not differ according to infection status, IgM levels decreased significantly at the sixth month, and this decline was associated with a reduced infection burden. Conclusions: In conclusion, IFNG and IL10 gene expression levels may serve as important indicators for predicting rejection after liver transplantation, whereas anti-α-Gal IgM levels may provide useful guidance in monitoring infection.