Vaccine-induced donor-specific HLA antibodies: a case report highlighting sensitization risks in renal transplant waitlisted patients

• Published in: Frontiers in immunology Vol. 16; p. 1567377
• Main Authors: Kakodkar, Pramath, Shekari, Nooshin, Mainra, Rahul, Webster, Destinie, Pearce, Twyla, Wu, Fang, Mostafa, Ahmed
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 14.03.2025
• Subjects: Adult; B-Lymphocytes - immunology; donor-specific HLA antibodies; Herpes Zoster Vaccine - administration & dosage; Herpes Zoster Vaccine - adverse effects; Herpes Zoster Vaccine - immunology; Histocompatibility Testing; HLA Antigens - immunology; Humans; Isoantibodies - blood; Isoantibodies - immunology; Kidney Transplantation; pneumococcal vaccine; Pneumococcal Vaccines - administration & dosage; Pneumococcal Vaccines - adverse effects; Pneumococcal Vaccines - immunology; renal transplant; Tissue Donors; vaccination in kidney transplant; vaccines induced HLA antibodies; Waiting Lists; zoster vaccine; vaccines induced HLA antibodies; donor-specific HLA antibodies; vaccination in kidney transplant; pneumococcal vaccine; renal transplant; zoster vaccine
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2025.1567377

In renal transplant waitlisted patients, vaccinations remain the standard of care for infection prevention. The vaccine and its adjuvant sensitizer can be potential sources for the induction of donor-specific antibodies (DSA) against human leukocyte antigens (HLA). These novel HLA antibodies can result in a positive flow cell crossmatch (FCXM), which can make a previously compatible live donor incompatible. We present an adult renal transplant waitlisted patient who has had multiple negative T-cell and B-cell FCXM with no detection of DSA at baseline. The patient then received a single dose of pneumococcal conjugate (PCV13) and a second dose of recombinant zoster vaccine (RZV). After these vaccinations, the patient's FCXM was positive for both T-cells and B-cells and the HLA class I antibodies (A1, 23, 24, 80; B44, 45, 76) showed a calculated panel reactive antibody (cPRA) of 51%. A1 and B44 DSA were detected which predicted incompatibility with the patient's planned live donor renal transplant. The patient had to enter the kidney-paired donation program instead and receive their transplantation after 16 months. RZV or PCV13 vaccines or their adjuvant components can potentially cause allosensitization in renal transplant waitlisted patients. The detection of DSA can result in reduced access to compatible transplants. With advances in HLA immunogenetics, better tools can monitor HLA-specific memory B-cells to provide crucial insights into the primary mechanism of action of HLA DSA antibody formation and suggest interventions to mitigate this memory B-cell activation.