Role of Anti-Vimentin Antibodies in Pre-Sensitized Korean Heart Transplant Patients

Purpose Presence of antibodies to donor specific human leukocyte antigens (HLA) is a well-known risk factor associated with outcome in heart transplantation (HTx). Recent studies have suggested that non-HLA antibodies could also be associated with outcomes. We sought to assess the combined effect of donor specific HLA antibodies and non-HLA anti-vimentin antibodies on graft outcome in Korean HTx patients. Methods Pre-transplant serum was analyzed in 192 adult patients who underwent HTx from January 2014 to December 2016 in four large transplant centers in Korea. Demographic and outcome data were obtained from the Korean Organ Transplantation Registry (KOTRY), an organization established in 2014 to collect data on transplant patients. Results Donor specific HLA antibodies (DSA) were present in 28 (14.6%) patients, while anti-vimentin antibodies were present in 98 (51.0%) patients. Anti-vimentin antibodies were more prevalent in males (p=0.029), but there were no significant differences in other demographic factors. Positive DSA was associated with a significantly higher rate of 3-month graft failure (log-rank p=0.001). Anti-vimentin antibody positivity was also an independent predictor for 3-month and 1-year graft failure (HRadjust 5.21, 95% CI 1.66-16.37, p=0.005; HRadjust 3.45, 95% CI 1.47-8.09, p=0.004, respectively). In DSA(+) patients, anti-vimentin antibody positivity further discriminated 1-year graft survival (long-rank p=0.002). Conclusion In our analysis of Korean HTx patients, presence of DSA and anti-vimentin antibodies were both associated with increased risk of graft failure at 1 year. Additionally, anti-vimentin antibody positivity further discriminated outcome in pre-sensitized patients. Pre-transplant assessment of anti-vimentin antibodies could help predict outcome and tailor immunotherapy in specific populations.