Introduction: Peroxisomal trans-2-enoyl-CoA reductase (PECR), a cell component of the mitochondria and peroxisomal membrane, is an enzyme involved in the lipid metabolism and fatty acid biosynthesis. PECR is strongly expressed in the kidney. Recently, it has been shown that anti-PECR antibodies could be associated with transplant glomerulopathy. Our hypothesis is that primary kidney disease could cause PECR up regulation and overexpression leading to recipient’s B cell and T cell autoimmunity. Hence, ultimately contributing to worse allograft outcome.

Methods: We retrospectively analyzed 105 consecutive kidney transplant recipients, transplanted between 1/2007 and 12/2009. All patients included in this study had a pre-transplant serum in addition to sera collected at regular intervals post-transplant. Sera were tested for anti-PECR auto-antibodies using LUMINEX technology and HLA class I and II antibodies using LABScreen SAB (One Lambda, Inc.). Mean Fluorescence Intensity (MFI) cut-off for PECR was defined based on normal male sera’s MFI’s average plus 2 standard deviations. For anti-HLA antibodies a 1,000 MFI cut-off was used.

Results: Pre-transplant anti-PECR antibodies were found in 19 recipients (18%). 18/19 (95%) recipients had persistent anti-PECR antibodies in their post-transplant sera. Furthermore, 15/18 (83%) pre-transplant/persistent anti-PECR recipients had NO DSA in their pre-transplant sera. Our control group consisted of the remaining 86 kidney transplant recipients without anti-PECR antibodies in their pre-transplant sera. Acute and chronic antibody mediated rejection (AMR) occurred significantly more in the pre-transplant/persistent anti-PECR group compared with the NO pre-transplant anti-PECR group. No difference between groups was observed regarding allograft loss (table1). Nevertheless, a longer follow-up would be necessary to better evaluate allograft loss.

Conclusions: This study shows a correlation between the presence of pre- and post-transplant auto-antibodies directed against PECR and acute and chronic antibody mediated rejection in kidney transplantation.

Terasaki, P.: Stockholder, One Lambda, Inc.

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