Antivimentin antibodies are an independent predictor of transplant-associated coronary artery disease after cardiac transplantation.
BACKGROUND
Transplant-associated coronary artery disease (TxCAD) is the most serious long-term complication after cardiac transplantation. Anti-endothelial antibodies are associated with disease, and one of the major endothelial antigens recognized in the sera of patients has been shown to be the protein filament vimentin. In this study, we investigated whether antivimentin antibodies are associated with TxCAD and whether their presence can be used to identify patients at high risk of developing angiographically detectable TxCAD.


METHODS
Up to 5 years after transplantation, 880 sequential sera (7.07+/-1.8 samples/patient) were collected retrospectively from 109 patients; the majority were collected in the first 2 years. Sera were assessed for antivimentin antibodies using ELISA. TxCAD was assessed by annual angiography.


RESULTS
Mean titres of antivimentin antibodies, calculated up to 1, 2, and 5 years, were significantly higher in patients who developed TxCAD than those who remained disease free (P<0.0001, P<0.0038, and P<0.0001, respectively). A predictive test based on the first-year mean vimentin titre alone (> or = 120) produced a test with 63% sensitivity and 76% specificity. Inclusion of persistent rejection or high 1-year mean titre (> or = 270) as a risk factor produced a test with 66% sensitivity and 82% specificity. Multivariate analysis of time to occurrence of transplant vasculopathy showed that mean titre at 1 or 2 years was an independent predictor of time until disease in the presence of all other variables.


CONCLUSIONS
Antivimentin antibodies are an independent predictor of TxCAD and can be used to identify some of the patients who are at high risk of developing this complication.
Jurcevic
S
S
National Heart & Lung Institute, Imperial College School of Medicine, Harefield Hospital, Middlesex, United Kingdom.
Ainsworth
M E
ME
Pomerance
A
A
Smith
J D
JD
Robinson
D R
DR
Dunn
M J
MJ
Yacoub
M H
MH
Rose
M L
ML
D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis*; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D014746:Vimentin / Q000276:immunology*
D000906:Antibodies; D014746:Vimentin