Successful ABO‐incompatible living donor kidney transplantation in a recipient who developed flow cytometry crossmatch‐positive donor‐specific class I HLA antibodies following COVID‐19 vaccination

Abstract

The effects of COVID-19 vaccination on alloimmunization and clinical impact in transplant candidates remain largely unknown. In a 61-year-old man who had no donor-specific antibodies (DSA) and was planned to undergo ABOincompatible kidney transplantation (ABOi KT), DSAs (anti-A24, anti-B51, and anti-Cw14) developed after COVID-19 vaccination. After desensitization therapy, antibody level was further increased, leading to flow cytometric crossmatch-positive status. Donor-specific T cell immunity using interferongamma ELISPOT was continuously negative, whereas SARS-CoV-2 specific T cell immunity was intact. After confirming the C1q-negative status of DSA, the patient received ABOi KT. The patient had stable graft function and suppressed alloimmunity up to 2 months after KT. COVID-19 vaccination might relate to alloimmunization in transplant candidates, and desensitization through immune monitoring can help guide transplantation.

COVID-19 infection and vaccination rarely impact HLA antibody profile in waitlisted renal transplant candidates- a multicenter cohort

“…However, a case report revealed a positive B cell flow cytometry crossmatch in a patient waiting for second kidney transplantation after receiving the COVID-19 vaccine, presumably due to the bystander activation of memory response by the COVID-19 vaccination [28] . Another case report of ABO incompatible living donor kidney transplant revealed appearance of new DSA following COVID-19 vaccination [29] .…”