Leveraging blood-based transcriptomics to detect acute cellular rejection in lung transplant

Acute cellular rejection (ACR) is one of the main risk factors for chronic allograft dysfunction, the primary contributor to poor long-term survival in lung transplant recipients. We sought to develop a blood-based transcriptomic risk score (TRS) to detect ACR in lung transplant recipients. We tested for the association of the TRS with ACR in a logistic mixed model. We analyzed 101 samples from 75 individuals. We identified 4 genes after application of the least absolute shrinkage and selection operator. The TRS was significantly associated with ACR (odds ratio (OR) 3.43, 95% confidence interval (CI) 1.86-7.14, p < 0.001). The TRS demonstrates robust discrimination between the 2 groups given an area under receiver operator curve above 0.8, which could lead to less invasive diagnosis of ACR and prediction of individuals at risk for ACR in the future. Further studies with larger sample size are needed to firmly establish the clinical utility of the TRS for ACR.