Horizons in TransplantationKidney transplantationAnti-vimentin Antibodies Present at the Time of Transplantation May Predict Early Development of Interstitial Fibrosis/Tubular Atrophy

- Elevated anti-vimentin antibody concentrations (>15 μg/mL) at the time of transplantation may be a risk factor for the development of interstitial fibrosis/tubular atrophy (IFTA).
- Elevated anti-vimentin antibody concentrations may predict inferior graft function over time.
- Graft loss rates were similar among all groups in this study. However, there was a trend toward earlier graft loss in the setting of anti-vimentin antibody concentrations >15 μg/mL.
- There was a trend toward increased mortality with patients with IFTA and anti-vimentin antibody concentration >15 μg/mL.

BackgroundAnti-vimentin (a cytoskeletal protein) autoantibodies in renal transplant recipients have been correlated with interstitial fibrosis/tubular atrophy (IFTA). In this study, we examine the association between pretransplantation anti-vimentin antibodies and the subsequent development of IFTA.MethodsSera obtained before renal transplantation from 97 transplant recipients were analyzed for the presence of anti-vimentin antibodies via Luminex assays to determine the concentration of anti-vimentin antibodies. Results were correlated with findings of IFTA on biopsy as well as graft function and patient and graft survival.ResultsIn our patient population, 56 of 97 patients were diagnosed by biopsy with IFTA 2.9 (±2.1) years after renal transplantation. Patients with IFTA on biopsy had higher mean concentration of anti-vimentin antibodies when compared to patients without IFTA (32.2 μg/mL [3.97-269.12 μg/mL] vs 14.57 μg/mL [4.71-87.81 μg/mL]). The risk of developing IFTA with a concentration of anti-vimentin antibody >15 μg/mL before transplantation was 1.96 (95% CI = 1.38-2.79, P = .011). Patients with elevated anti-vimentin antibody concentrations (>15 μg/mL) at the time of transplantation also had a higher risk of developing IFTA (81.4% vs 41.2%; P < .05). In addition, graft function was worse at 1, 3, and 5 years posttransplantation in patients with elevated concentrations of pretransplantation anti-vimentin antibody. Although there were more graft losses in the IFTA groups (49.12% vs 25.64%, P = .021) and the IFTA patients loss their grafts earlier (4.3 years vs 3.6 years), there was no statistical difference in graft loss rates.ConclusionsPretransplantation anti-vimentin antibody concentrations >15 μg/mL may be a risk factor for IFTA.