Abstract 15097: Incidence and Outcomes Related to Pre-Transplant Anti-Vimentin Antibodies in the Cardiac Transplantation Population
Background: In cardiac transplant recipients, the development of antibodies to the endothelial intermediate filament protein vimentin (anti-vimentin antibodies, AVA) has been associated with rejection and poor outcomes. However, the incidence of these antibodies prior to transplantation and their potential association with early rejection has not been investigated.
METHODS: Pre-transplant serum was analyzed from 50 patients who underwent de novo cardiac transplant (pediatric or adult) at Johns Hopkins during the previous 10 year period. AVA levels were measured using a solid phase Luminex® immunoassay. Demographic, one year rejection, and survival data were obtained from the Hopkins transplant database and electronic medical record. Cellular rejection was defined by ISHLT grade 2R or greater. Antibody mediated rejection was defined as presence of pericapillary C4d deposition.
RESULTS: The incidence of pre-transplant AVA was 34%. Those patients with AVA positivity were younger (p=0.03) and there was a trend toward increasing incidence in females (p=0.08). Other demographic data were similar including etiology of heart failure, prior LVAD implantation, recent pregnancy, and presence of non-self HLA antibody in the same pre-transplant sample (table). AVA positivity did not predict rejection in the 1st year post-transplant, including time to first episode, compared to AVA negative patients (table). There was no difference in rejection-free graft survival (53 vs. 52%, p=0.85) at 1 year. Similarly there was no difference in graft survival at 1 year (82 vs. 88%, p=0.56) or graft survival at a median follow up of 23 and 26 months, respectively (76 vs. 85%, p=0.41).
Conclusions: Antibodies to the endothelial protein vimentin are common in the cardiac transplant population prior to transplant. In this pilot analysis, the presence of detectable AVA did not correlate with post-transplant rejection or graft survival. These findings should be validated in a larger cohort.
- © 2013 by American Heart Association, Inc.