Abstract
The impact of COVID-19 vaccination on the alloimmunity of transplant candidates is unknown. We report a case of positive B cell flow cytometry crossmatch in a patient waiting for second kidney transplantation, 37 days after receiving the COVID-19 vaccine. The preliminary crossmatch, using sample collected before COVID-19 vaccination, was negative. The antibodies to mismatched donor HLA-DR7 were detected only with multi-antigen beads but not with single-antigen beads, excluding possible prozone effects in solid-phase antibody assays. The crossmatches were positive with HLA-DR7-positive surrogates (n = 2) while negative with HLA-DR7-negative surrogates (n = 3), which confirms the HLA-DR7 alloreactivity. The antigen configurations on B lymphocytes are similar to that on the multi-antigen beads while distinct from the single-antigen beads. HLA-DR7 was the repeating mismatched antigen with the failing first kidney allograft. The newly emerged antibody to HLA-DR7 probably is the consequence of bystander activation of memory response by the COVID-19 vaccination. This case highlights the importance of verifying allo-sensitization history and utilizing multiple assays, including cell-based crossmatch and solid-phase assays with multi-antigens. COVID-19 immunization may deserve special attention when assessing the immunological risk before and after organ transplantation.
Keywords: alloantibody; clinical research/practice; crossmatch; histocompatibility; immunobiology; kidney transplantation/nephrology; kidney transplantation: living donor; panel-reactive antibody (PRA); translational research/science; vaccine.
【저자키워드】 Vaccine, clinical research/practice, translational research/science, alloantibody, crossmatch, histocompatibility, immunobiology, kidney transplantation/nephrology, kidney transplantation: living donor, panel-reactive antibody (PRA), 【초록키워드】 COVID-19, Vaccine, COVID-19 vaccine, Lymphocytes, antibody, risk, immunization, flow cytometry, Antigen, kidney, B cell, COVID-19 vaccination, Patient, antigens, B lymphocyte, Antibody assays, Donor, alloantibody, crossmatch, histocompatibility, immunobiology, memory response, organ transplantation, Allograft, alloimmunity, B lymphocytes, bystander, Activation, candidate, multi, positive, organ, alloreactivity, Effect, immunological, prozone, HLA-DR7, living donor, highlight, collected, assays, receiving, translational, 【제목키워드】 Antibody testing, flow cytometry,