Anti-vimentin antibodies-associated recurrent antibody-mediated rejection after kidney transplantation: a case report

Acute antibody-mediated rejection without detectable human leukocyte antigen donor-specific antibodies has been increasingly reported. We describe a case of antibody-mediated rejection associated with pre-existing anti-vimentin antibodies in a kidney transplant recipient with no detectable human leukocyte antigen donor-specific antibodies on Pretransplant evaluation. A non-human leukocyte antigen antibody panel identified anti-vimentin antibodies before transplantation. Despite treatment with methylprednisolone, plasmapheresis, intravenous immunoglobulin, and rituximab, antibody mediated rejection recurred and led to progressive graft dysfunction. This case underscores the importance of expanded pretransplant screening for preformed autoantibodies, particularly in recipients receiving long-term hemodialysis, and highlights the potential need for more intensive monitoring and management in patients with anti-vimentin antibodies.