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

• Published in: HLA : immune response genetics 2022-07, Vol.100 (1), p.52-58
• Main Authors: Kim, Jae Kwon, Bae, Hyunjoo, Ko, Geon Young, Lee, Jihyun, Jung, Jin, Jekarl, Dong Wook, Choi, Ae‐Ran, Lee, Sangyoon, Chung, Byung Ha, Yang, Chul Woo, Park, Sun Cheol, Oh, Eun‐Jee
• Format: Article
• Language: English
• Subjects: ABO incompatible kidney transplantation; COVID‐19 vaccination; desensitization; donor‐specific HLA antibodies; immune monitoring
• ISSN: 2059-2302; 2059-2310
• DOI: 10.1111/tan.14649

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 ABO‐incompatible 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 interferon‐gamma 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.