Improving precision in predicting alloreactivity is an important unmet need and may
require individualized consideration of non-HLA antibodies. We report a 21-year-old
man with kidney failure from immunoglobulin A nephropathy who met all traditional
criteria for a “low-risk” transplant for immune memory. He was unsensitized and received
a haplotype-matched living donor kidney transplant from his mother. There were no
anti-HLA donor-specific antibodies and flow cross-match was negative. After immediate
function, he developed delayed graft function on postoperative day 2. The transplant
biopsy specimen was suggestive of antibody-mediated rejection and acute tubular injury
with increased vimentin proximal tubular expression compared to the implantation biopsy
specimen. He had a history of juvenile idiopathic arthritis, and non-HLA antibody
screening demonstrated preformed anti-vimentin antibody. He was successfully treated
with plasmapheresis, intravenous immunoglobulin, antithymocyte globulin, and methylprednisolone,
with renal recovery. The follow-up biopsy specimen demonstrated decreased vimentin
expression with decreased alloinflammation, and graft function remains stable at 1
year posttransplantation (estimated glomerular filtration rate, 62 mL/min/1.73 m2). We postulate that preformed anti-vimentin autoantibodies bound to vimentin expressed
on apoptotic tubular epithelial cells induced by ischemia-reperfusion injury and to
constitutively expressed vimentin on peritubular capillaries and podocytes. Our case
is suggestive of the involvement of anti-vimentin antibody, for which the pathogenic
epitopes may be exposed during ischemia-reperfusion injury.
Index Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Kidney DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Carpe diem-time to transition from empiric to precision medicine in kidney transplantation.Am J Transplant. 2018; 18: 1615-1625
- Sensitization in Transplantation: Assessment of Risk (STAR) 2017 Working Group meeting report.Am J Transplant. 2018; 18: 1604-1614
- The Banff 2017 Kidney Meeting Report: revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials.Am J Transplant. 2018; 18: 293-307
- Impact of non-human leukocyte antigen-specific antibodies in kidney and heart transplantation.Front Immunol. 2017; 8: 434
- Localization of proliferating cell nuclear antigen, vimentin, c-Fos, and clusterin in the postischemic kidney. Evidence for a heterogenous genetic response among nephron segments, and a large pool of mitotically active and dedifferentiated cells.J Clin Invest. 1994; 93: 2175-2188
- Ischemic acute renal failure induces the expression of a wide range of nephrogenic proteins.Am J Physiol Regul Integr Comp Physiol. 2006; 290: R861-R870
- Markers of endothelial-to-mesenchymal transition: evidence for antibody-endothelium interaction during antibody-mediated rejection in kidney recipients.J Am Soc Nephrol. 2016; 27: 324-332
- Markers of graft microvascular endothelial injury may identify harmful donor-specific anti-HLA antibodies and predict kidney allograft loss.Am J Transplant. 2019; 19: 2434-2445
- Hyperacute antibody-mediated rejection associated with red blood cell antibodies.Transplant Direct. 2019; 5: e477
- Role of anti-vimentin antibodies in allograft rejection.Hum Immunol. 2013; 74: 1459-1462
- Vimentin antibody production in transplant patients and immunomodulatory effects of vimentin in-vitro.Hum Immunol. 2013; 74: 1463-1469
- Identification of a caspase-9 substrate and detection of its cleavage in programmed cell death during mouse development.J Biol Chem. 2001; 276: 41237-41244
- Cell surface expression of intermediate filament proteins vimentin and lamin B1 in human neutrophil spontaneous apoptosis.J Leuk Biol. 2006; 79: 489-498
- Evaluation of anti-citrullinated type II collagen and anti-citrullinated vimentin antibodies in patients with juvenile idiopathic arthritis.Pediatr Rheumatol Online J. 2013; 11: 31
- Anti-MCV and anti-CCP antibodies-diagnostic and prognostic value in children with juvenile idiopathic arthritis (JIA).Clin Rheumatol. 2016; 35: 2699-2706
- Antivimentin antibodies are an independent predictor of transplant-associated coronary artery disease after cardiac transplantation.Transplantation. 2001; 71: 886-892
- Incidence and early outcomes associated with pre-transplant antivimentin antibodies in the cardiac transplantation population.Clin Transplant. 2015; 29: 685-688
- The autoimmune response to vimentin after renal transplantation in nonhuman primates is immunosuppression dependent.Transplantation. 2005; 80: 385-393
- Anti-vimentin antibodies present at the time of transplantation may predict early development of interstitial fibrosis/tubular atrophy.Transplant Proc. 2016; 48: 2023-2033
- Immunoglobulin isotype switching of antibodies to vimentin is associated with development of transplant glomerulopathy following human renal transplantation.Transpl Immunol. 2017; 45: 42-47
- Role of anti-vimentin antibodies in renal transplantation.Transplantation. 2014; 98: 72-78
Article Info
Publication History
Published online: September 09, 2019
Footnotes
Complete author and article information provided before references.
Identification
Copyright
© 2019 by the National Kidney Foundation, Inc.
