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Daoud A, Soliman K, Posadas Salas MA, Vaishnav S, Uehara G, Abdelkader A, Fulop T, Casey MJ. Development of donor specific antibodies after SARS-CoV-2 vaccination: What do we know so far? World J Meta-Anal 2024; 12:91264. [DOI: 10.13105/wjma.v12.i2.91264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/18/2024] [Accepted: 06/07/2024] [Indexed: 06/14/2024] Open
Abstract
Vaccination against Coronavirus disease-19 (COVID-19) was pivotal to limit spread, morbidity and mortality. Our aim is to find out whether vaccines against COVID-19 lead to an immunological response stimulating the production of de novo donor specific antibodies (DSAs) or increase in mean fluorescence intensity (MFI) of pre-existing DSAs in kidney transplant recipients (KTRs). This study involved a detailed literature search through December 2nd, 2023 using PubMed as the primary database. The search strategy incorporated a combination of relevant Medical Subject Headings terms and keywords: "COVID-19", "SARS-CoV-2 Vaccination", "Kidney, Renal Transplant", and "Donor specific antibodies". The results from related studies were collated and analyzed. A total of 6 studies were identified, encompassing 460 KTRs vaccinated against COVID-19. Immunological responses were detected in 8 KTRs of which 5 had increased MFIs, 1 had de novo DSA, and 2 were categorized as either having de novo DSA or increased MFI. There were 48 KTRs with pre-existing DSAs prior to vaccination, but one study (Massa et al) did not report whether pre-existing DSAs were associated with post vaccination outcomes. Of the remaining 5 studies, 35 KTRs with pre-existing DSAs were identified of which 7 KTRs (20%) developed de novo DSAs or increased MFIs. Overall, no immunological response was detected in 452 (98.3%) KTRs. Our study affirms prior reports that COVID-19 vaccination is safe for KTRs, especially if there are no pre-existing DSAs. However, if KTRs have pre-existing DSAs, then an increased immunological risk may be present. These findings need to be taken cautiously as they are based on a limited number of patients so further studies are still needed for confirmation.
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Affiliation(s)
- Ahmed Daoud
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
- Department of Medicine, Cairo University Medical School, Cairo 11211, Egypt
| | - Karim Soliman
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
- Department of Medicine, Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC 29425, United States
| | - Maria Aurora Posadas Salas
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Sakshi Vaishnav
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Genta Uehara
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Ahmed Abdelkader
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Tibor Fulop
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
- Department of Medicine, Division of Nephrology, Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC 29425, United States
| | - Michael J Casey
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
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Al Attas RA, AlDhafir R, Mohammed A, AlAbduladheem D, Awaji M, AlAjlan K, AlOtaibi A, Bamrdouf R, Alabadi A. Impact of COVID-19 pandemic on transplant laboratories: How to mitigate? Heliyon 2024; 10:e26419. [PMID: 38404840 PMCID: PMC10884516 DOI: 10.1016/j.heliyon.2024.e26419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
A positive flow cytometry crossmatch (FCXM) due to donor specific antibodies (DSA) constitutes a risk for kidney transplantation; such a finding may indicates an unacceptable donor for this patient. However, positive FCXM in the absence of DSA is considered discordant and need further investigations. During COVID-19 pandemic, we observed 22% discordant results out of 445 FCXM performed during eight months period in our laboratory and another 7% were invalid due to high background negative control (NC). No study has addressed the impact of COVID-19 pandemic on FCXM and the overall pre-kidney transplant workups or described a solution to deal with these non-specific reactivities. Herein, we analyzed all FCXM results in SARS-CoV-2 seropositive patients and addressed how this pandemic affected significantly the pre-kidney transplant workups, highlighting both technical and financial implications. We also shared our modified FCXM procedures using dithiotheritol (DTT) sera treatment or blocking donor cells with negative control human serum (NCS) which we found to be successful to abrogate 98% of all discordant FCXM results and to validate all invalid results due to high background NC. In conclusion, COVID-19 pandemic has affected our HLA laboratory significantly by creating many false positive or invalid crossmatch results. Transplant laboratories must consider this before test interpretations and immune risk assessments. We recommend the use of DTT serum treatment to remove nonspecific bindings in the sera of kidney transplant candidates and the use of NCS-blocked donor cells to correct high background when performing FCXM in transplant candidates or donors with recent history of SARS-CoV-2 immunization respectively.
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Affiliation(s)
- Rabab Ali Al Attas
- Histocompatibility& Immunoigenetics (HIL), Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
| | - Raha AlDhafir
- Histocompatibility& Immunoigenetics (HIL), Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
| | - Amani Mohammed
- Histocompatibility& Immunoigenetics (HIL), Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
| | - Dalal AlAbduladheem
- Histocompatibility& Immunoigenetics (HIL), Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
| | - Mohammad Awaji
- Histocompatibility& Immunoigenetics (HIL), Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
| | - Kenana AlAjlan
- Histocompatibility& Immunoigenetics (HIL), Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
| | - Ahmed AlOtaibi
- Histocompatibility& Immunoigenetics (HIL), Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
| | - Rafah Bamrdouf
- Histocompatibility& Immunoigenetics (HIL), Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
| | - Abdulnaser Alabadi
- Multiorgan Transplant Division, King Fahad Specialist Hospital-Dammam (KFSH-D), Saudi Arabia
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Abu-Khader A, Hu Q, Kamar F, Galaszkiewicz I, Wang W, Khan F, Berka N. Low incidence of de novo HLA antibodies after COVID-19 vaccination: A cohort study of patients awaiting kidney transplantation. Transpl Infect Dis 2023; 25:e14105. [PMID: 37650468 DOI: 10.1111/tid.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/17/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Antibodies against human leukocyte antigen (anti-HLA Abs) are associated with an increased risk of allograft loss. Herein, we report the prospective follow-up for anti-HLA Abs formation in 103 patients with end-stage kidney disease on the waiting list for transplantation who underwent COVID-19 vaccination. PATIENTS AND METHODS Sera were tested before and after vaccination using Luminex technology. The cohort comprised of 62 males and 41 females with a mean age of 56 ± 14 years. The patients received BNT162b2 (80.4%), mRNA-1273 (18.5%), AZD1222 (0.40%), or ChAdOx1-S (0.80%) vaccine. Patients were tested before and within 119 ± 50, 95 ± 46 and 25 ± 26 days after the first, second, and third dose of the vaccine, respectively. RESULTS No significant change in calculated panel reactive antibody (cPRA) after vaccination was seen. Although 98.1% of patients had no change in anti-HLA Abs profile or cPRA after vaccination, two patients (1.9%) developed de novo anti-HLA Abs against class I or II HLA antigens. In those two patients, the cPRA changed from 0% and 63% at baseline to 9% and 90% after vaccination, respectively. Both patients received the BNT162b2 mRNA-based vaccine. The earliest detected anti-HLA Abs was 18 days after the first dose. CONCLUSION In rare cases, new anti-HLA antibodies were observed after COVID-19 vaccination, with potential implications for transplantation. The low incidence of this phenomenon is outweighed by the clinical benefits of vaccination.
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Affiliation(s)
- Ahmad Abu-Khader
- Transplant Immunology and Histocompatibility Laboratory, Department of Pathology, University of Texas Southwestern Medical Center, Texas, USA
| | - Qian Hu
- Histocompatibility and Immunogenetics Laboratory, Alberta Precision Laboratories, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fareed Kamar
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Iwona Galaszkiewicz
- Histocompatibility and Immunogenetics Laboratory, Alberta Precision Laboratories, Alberta, Canada
| | - Wenjie Wang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Faisal Khan
- Histocompatibility and Immunogenetics Laboratory, Alberta Precision Laboratories, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Noureddine Berka
- Histocompatibility and Immunogenetics Laboratory, Alberta Precision Laboratories, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
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Yu B, Tamargo C, Brennan DC, Kant S. Measures to Increase Immunogenicity of SARS-CoV-2 Vaccines in Solid Organ Transplant Recipients: A Narrative Review. Vaccines (Basel) 2023; 11:1755. [PMID: 38140160 PMCID: PMC10748337 DOI: 10.3390/vaccines11121755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Purpose of review: To review the data on the immunogenicity of COVID-19 vaccines, administered by different strategies, in solid organ transplant recipients (SOTRs). Recent findings: COVID-19 booster vaccines were given to SOTRs as a widespread practice in many transplant centers, mostly as the third and/or fourth dose in an extended vaccine series, with a significantly improved humoral response compared with the initial two-dose scheme. However, one-third of SOTRs remained unresponsive, despite these boosters. Next steps: Vaccination with standard dosing remains the most feasible strategy for attaining protection against COVID-19. Additional booster doses and temporarily holding or reducing mycophenolate mofetil/mycophenolic acid may provide immunogenicity to vaccines, according to recent studies demonstrating some efficacy with these measures. Preexposure prophylaxis with monoclonal antibodies showed benefit in immunocompromised patients but is no longer recommended by the National Institutes of Health (NIH) due to diminished efficacy against Omicron and recent variants. Screening for the presence and titers of SARS-CoV-2-specific antibodies in SOTRs is not recommended in most clinical settings. T cell-based techniques are needed to evaluate vaccine efficacy and risk of infection. As SARS-CoV-2 continues to evolve, new vaccines based on conservative protein component/complexes of the COVID virus, in addition to its spike protein, are warranted to offer prolonged protection.
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Affiliation(s)
- Bo Yu
- Department of Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, MD 21201, USA;
| | - Christina Tamargo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Daniel C. Brennan
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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5
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Drenko P, Kacer M, Kielberger L, Vlas T, Topolcan O, Kucera R, Reischig T. Safety and efficacy of one and two booster doses of SARS-CoV-2 mRNA vaccines in kidney transplant recipients: A randomized clinical trial. Transpl Infect Dis 2023; 25:e14150. [PMID: 37724748 DOI: 10.1111/tid.14150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Kidney transplant recipients are at risk for a severe course of COVID-19 with a high mortality rate. A considerable number of patients remains without a satisfactory serological response after the baseline and adjuvant SARS-CoV-2 vaccination schedule. METHODS In this prospective, randomized study, we evaluated the efficacy and safety of one and two booster doses of mRNA vaccines (either mRNA-1273 or BNT162b2) in 125 COVID-19 naive, adult kidney transplant recipients who showed an insufficient humoral response (SARS-CoV-2 IgG <10 AU/ml) to the previous 2-dose vaccination schedule. The primary outcome was the difference in the rate of a positive antibody response (SARS-CoV-2 IgG ≥10 AU/ml) between one and two booster doses at 1 month after the final booster dose. RESULTS A positive humoral response was observed in 36 (62%) patients receiving two booster doses and in 28 (44%) patients receiving one booster dose (odds ratio [OR], 2.10, 95% confidence interval [CI], 1.02-4.34, p = .043). Moreover, median SARS-CoV-2 IgG levels were higher with two booster doses (p = .009). The number of patients with positive virus neutralizing antibody (VNA) levels was numerically higher with two booster doses compared to one booster dose, but without statistical significance (66% vs. 50%, p = .084). There was no significant difference in positive seroconversions rate and antibody levels between mRNA-1273 and BNT162b2. CONCLUSION A higher number of kidney transplant recipients achieved a positive antibody response after two booster doses compared to one booster dose.
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Affiliation(s)
- Petr Drenko
- Department of Internal Medicine I, Faculty of Medicine in Pilsen, Charles University, and University Hospital, Pilsen, Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Kacer
- Department of Internal Medicine I, Faculty of Medicine in Pilsen, Charles University, and University Hospital, Pilsen, Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Lukas Kielberger
- Department of Internal Medicine I, Faculty of Medicine in Pilsen, Charles University, and University Hospital, Pilsen, Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Tomas Vlas
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University, and University Hospital, Pilsen, Czech Republic
| | - Ondrej Topolcan
- Department of Immunochemistry Diagnostics, Faculty of Medicine in Pilsen, Charles University, and University Hospital, Pilsen, Czech Republic
| | - Radek Kucera
- Department of Immunochemistry Diagnostics, Faculty of Medicine in Pilsen, Charles University, and University Hospital, Pilsen, Czech Republic
- Department of Pharmacology and Toxicology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Tomas Reischig
- Department of Internal Medicine I, Faculty of Medicine in Pilsen, Charles University, and University Hospital, Pilsen, Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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6
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Roll GR, Bray RA, Cooper M, Eagar TN, Gebel HM, Vranic GM, Hitchman KM, Houp J, Kamoun M, Killian J, Kim J, Kumar V, Levine M, Lovasik BP, Lunow-Luke T, Parsons RF, Pattanayak V, Ranch D, Shah A, Stock PG, Timofeeva OA, Trofe-Clark J, Wongjirad C, Yeh H, Yi S, Rajalingam R. COVID-19 infection and vaccination rarely impact HLA antibody profile in waitlisted renal transplant Candidates- a multicenter cohort. Hum Immunol 2023; 84:278-285. [PMID: 36868898 PMCID: PMC9946887 DOI: 10.1016/j.humimm.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
Although rare, infection and vaccination can result in antibodies to human leukocyte antigens (HLA). We analyzed the effect of SARS-CoV-2 infection or vaccination on HLA antibodies in waitlisted renal transplant candidates. Specificities were collected and adjudicated if the calculated panel reactive antibodies (cPRA) changed after exposure. Of 409 patients, 285 (69.7 %) had an initial cPRA of 0 %, and 56 (13.7 %) had an initial cPRA > 80 %. The cPRA changed in 26 patients (6.4 %), 16 (3.9 %) increased, and 10 (2.4 %) decreased. Based on cPRA adjudication, cPRA differences generally resulted from a small number of specificities with subtle fluctuations around the borderline of the participating centers' cutoff for unacceptable antigen listing. All five COVID recovered patients with an increased cPRA were female (p = 0.02). In summary, exposure to this virus or vaccine does not increase HLA antibody specificities and their MFI in approximately 99 % of cases and 97 % of sensitized patients. These results have implications for virtual crossmatching at the time of organ offer after SARS-CoV-2 infection or vaccination, and these events of unclear clinical significance should not influence vaccination programs.
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Affiliation(s)
- Garrett R. Roll
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Robert A. Bray
- Histocompatibility and Molecular Immunogenetics Laboratory, Emory University, Atlanta, GA, United States
| | - Matthew Cooper
- Medstar-Georgetown Transplant Institute, Washington, DC, United States
| | - Todd N. Eagar
- Immunogenetics and Transplantation Laboratory Houston Methodist, Houston, TX, United States
| | - Howard M. Gebel
- Histocompatibility and Molecular Immunogenetics Laboratory, Emory University, Atlanta, GA, United States
| | - Gayle M. Vranic
- Medstar-Georgetown Transplant Institute, Washington, DC, United States
| | - Kelley M.K. Hitchman
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, San Antonio, TX, United States
| | - Julie Houp
- Department of Laboratory Medicine, University of Alabama Medical Center, Birmingham, AL, United Kingdom
| | - Malek Kamoun
- Department of Pathology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - John Killian
- Department of Surgery, University of Alabama Medical Center, Birmingham, AL, United Kingdom
| | - Jim Kim
- Department of Surgery, University of Southern California, Los Angeles, CA, United States
| | - Vineeta Kumar
- Department of Medicine, Division of Nephrology, University of Alabama, Birmingham, AL, United Kingdom
| | - Matthew Levine
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Brendan P. Lovasik
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Tyler Lunow-Luke
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Ronald F. Parsons
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Vikram Pattanayak
- Department of Pathology, Massachusetts General Hospital, Boston MA, United States
| | - Daniel Ranch
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Anushi Shah
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Peter G. Stock
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Olga A. Timofeeva
- Department of Pathology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Jennifer Trofe-Clark
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Chelsey Wongjirad
- Department of Surgery, University of Southern California, Los Angeles, CA, United States
| | - Heidi Yeh
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Stephanie Yi
- Department of Surgery, Houston Methodist, Houston, TX, United States
| | - Raja Rajalingam
- Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California San Francisco, San Francisco, CA, United States.
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Antal O, Daciana Elec A, Muntean A, Moisoiu T, Melinte RM, Elec FI. The immunologically high-risk kidney recipient in the early post-COVID-19 period. To do or not to do? A case report. Front Med (Lausanne) 2023; 10:1147835. [PMID: 37035338 PMCID: PMC10076652 DOI: 10.3389/fmed.2023.1147835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Kidney transplantation is nowadays the treatment of choice for end-stage kidney disease (ESKD), and it is the most performed organ transplantation. During the COVID-19 pandemic, kidney-transplant recipients appeared to be at higher risk of morbidity and mortality due to severe forms of illness. The result was a decrease in the number of solid organs transplants worldwide, with patients' reduced chance of receiving transplants. The best timing for surgery after COVID-19 infection is still controversial since most of the available data come from study periods with zero or low prevalence of vaccination and COVID-19 variants with high mortality rates. The American Society of Anesthesiologists (ASA) and the Anesthesia Patient Safety Foundation (APSF) Joint Statement on Elective Surgery/Procedures and Anesthesia for Patients after COVID-19 Infection states that elective surgery should be delayed for 7 weeks after a SARS-CoV-2 infection in unvaccinated patients while making no clear statement for vaccinated ones, or those which have already been infected with the virus. Kidney transplant, as opposed to tissue transplant, is not an elective surgery, so the question raised is whether to do it or not. We present the case of a hyper-immunized 47-year-old male patient with end-stage chronic kidney disease who received a second kidney transplant, despite having a mild SARS-COV 2 infection just 2 weeks before his transplantation surgery.
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Affiliation(s)
- Oana Antal
- Department of Anaesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Alina Daciana Elec
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Adriana Muntean
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Tudor Moisoiu
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
- Department of Urology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Razvan Marian Melinte
- Department of Anatomy, Dimitrie Cantemir University, Târgu-Mureş, Romania
- Department of Orthopedics and Trauma Surgery, Humanitas Hospital, Cluj-Napoca, Romania
- *Correspondence: Razvan Marian Melinte
| | - Florin Ioan Elec
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
- Department of Urology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Anatomy, Dimitrie Cantemir University, Târgu-Mureş, Romania
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8
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Awaji M, Alajlan K, Shaikh A, Alkebasi S, Kutty C, Alshami A, Attas RAA. HLA Sensitization in the Era of COVID-19: Single-Center Experience. Transplant Proc 2022; 54:2658-2662. [PMID: 36372565 PMCID: PMC9537251 DOI: 10.1016/j.transproceed.2022.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
It is well known that several viral infections are capable of triggering the formation of HLA antibodies; however, an association between SARS-CoV-2 and the development of anti-HLA antibodies is not yet confirmed. In this study, we compared the prevalence of HLA antibody before and after COVID-19 infection in a cohort of 3 groups included 58 healthy nonsensitized employees (HNEs), 130 kidney transplant recipients (KTRs), and 62 kidney transplant candidates. There were no significant changes observed in HLA class I antibodies in any of the groups, but evaluation of antibodies to HLA class II revealed a significant change in the KTR group (P = .0184) after acquiring COVID-19 infection and in the HNE group (P = .0043) when compared to the reported prevalence in a similar population. Although we observed the emergence of convalescent de novo donor-specific antibodies in 2 patients, we did not encounter any rejection episodes in the KTR group. Finally, the results of flow cytometry crossmatch in the HNE group were not consistent with the state of antibodies. In conclusion, COVID-19 infection has the potential to produce class II antibodies but with little effect on preexisting sensitization. These antibodies are likely to be transient and not necessarily causing positive crossmatch with the corresponding antigens at the proper mean fluorescent intensity and therefore should not affect access to transplantation. There is a need for further evaluation to ascertain the genuineness of these antibodies and their exact effect on transplant readiness and outcomes.
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Affiliation(s)
- Mohammad Awaji
- Histocompatibility & Immunogenetics Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Kenana Alajlan
- Histocompatibility & Immunogenetics Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Alaa Shaikh
- Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Shaima Alkebasi
- Histocompatibility & Immunogenetics Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Clara Kutty
- Histocompatibility & Immunogenetics Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Alanoud Alshami
- Division of Pediatric Nephrology and Kidney Transplant, Multiorgan Transplant Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Rabab Ali Al Attas
- Histocompatibility & Immunogenetics Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia,Address correspondence to Rabab Ali Al Attas MD, F (ACHI), D (ABMLI), Consultant Immunopathologist & Immunogeneticist, Director, Histocompatibility & Immunogenetics Lab & Head, Immunology/Serology Laboratory, Department of Pathology and Lab Medicine, King Fahad Specialist Hospital-Dammam, Al Muraikibat, Amer Bin Thabit St., Building 6, Office 2, PO BOX 15215, Dammam 31444, MBC 35, Saudi Arabia. Tel: (+966) 138043333, ext. 6737, Fax: (+966) 138042222
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9
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Comparison of the Immune Response After an Extended Primary Series of COVID-19 Vaccination in Kidney Transplant Recipients Receiving Standard Versus Mycophenolic Acid-sparing Immunosuppressive Regimen. Transplant Direct 2022; 8:e1393. [PMID: 36312516 PMCID: PMC9605792 DOI: 10.1097/txd.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED Two doses of coronavirus disease 2019 vaccination provide suboptimal immune response in transplant patients. Mycophenolic acid (MPA) is one of the most important factors that blunts the immune response. We studied the immune response to the extended primary series of 2 doses of AZD1222 and a single dose of BNT162b2 in kidney transplant patients who were on the standard immunosuppressive regimen compared to those on the MPA-sparing regimen. METHODS The kidney transplant recipients who were enrolled into the study were divided into 2 groups based on their immunosuppressive regimen. Those on the standard immunosuppressive regimen received tacrolimus (TAC), MPA, and prednisolone (standard group). The patients in the MPA-sparing group received mammalian target of rapamycin inhibitors (mTORi) with low dose TAC plus prednisolone (MPA-sparing group). The vaccination consisted of 2 doses of AZD1222 and a single dose of BNT162b2. RESULTS A total of 115 patients completed the study. There were 76 (66.08%) patients in the standard group and 39 (33.91%) patients in the MPA-sparing group. The overall median anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) S antibody level at 4 wk after vaccine completion was 676.64 (interquartile range = 6.02-3644.03) BAU/mL with an 80% seroconversion rate. The MPA-sparing group achieved higher anti-SARS-CoV-2 S antibody level compared to the standard group (3060.69 and 113.91 BAU/mL, P < 0.001). The seroconversion rate of MPA-sparing and standard groups were 97.4% and 71.1%, respectively (P < 0.001). The anti-HLA antibodies did not significantly increase after vaccination. CONCLUSIONS The extended primary series of 2 doses of AZD1222 and a single dose of BNT162b2 provided significant humoral immune response. The MPA-sparing regimen with mTORi and low dose TAC had a higher ant-SARS-CoV-2 S antibody level and seroconversion rate compared to the participants in the standard regimen.
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10
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Mrak D, Sieghart D, Simader E, Tobudic S, Radner H, Mandl P, Göschl L, Koblischke M, Hommer N, Wagner A, Mayer M, Schubert L, Hartl L, Kozbial K, Hofer P, Kartnig F, Hummel T, Kerschbaumer A, Deimel T, Puchner A, Gudipati V, Thalhammer R, Munda P, Uyanik-Ünal K, Zuckermann A, Novacek G, Reiberger T, Garner-Spitzer E, Reindl-Schwaighofer R, Kain R, Winkler S, Smolen JS, Stiasny K, Fischer GF, Perkmann T, Haslacher H, Zeitlinger M, Wiedermann U, Aberle JH, Aletaha D, Heinz LX, Bonelli M. Heterologous vector versus homologous mRNA COVID-19 booster vaccination in non-seroconverted immunosuppressed patients: a randomized controlled trial. Nat Commun 2022; 13:5362. [PMID: 36097029 PMCID: PMC9467419 DOI: 10.1038/s41467-022-33036-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
Impaired response to COVID-19 vaccination is of particular concern in immunosuppressed patients. To determine the best vaccination strategy for this vulnerable group we performed a single center, 1:1 randomized blinded clinical trial. Patients who failed to seroconvert upon two mRNA vaccinations (BNT162b2 or mRNA-1273) are randomized to receive either a third dose of the same mRNA or the vector vaccine ChAdOx1 nCoV-19. Primary endpoint is the difference in SARS-CoV-2 spike antibody seroconversion rate between vector and mRNA vaccinated patients four weeks after the third dose. Secondary outcomes include cellular immune responses. Seroconversion rates at week four are significantly higher in the mRNA (homologous vaccination, 15/24, 63%) as compared to the vector vaccine group (heterologous vaccination, 4/22, 18%). SARS-CoV-2-specific T-cell responses are reduced but could be increased after a third dose of either vector or mRNA vaccine. In a multivariable logistic regression analysis, patient age and vaccine type are associated with seroconversion. No serious adverse event is attributed to COVID-19 booster vaccination. Efficacy and safety data underline the importance of a booster vaccination and support the use of a homologous mRNA booster vaccination in immunosuppressed patients.Trial registration: EudraCT No.: 2021-002693-10.
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Affiliation(s)
- Daniel Mrak
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniela Sieghart
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Simader
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Selma Tobudic
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Helga Radner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lisa Göschl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Nikolaus Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Angelika Wagner
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Margareta Mayer
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Lorenz Schubert
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Lukas Hartl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Karin Kozbial
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Philipp Hofer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Felix Kartnig
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Hummel
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Deimel
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Antonia Puchner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Venugopal Gudipati
- Institute of Hygiene and Applied Immunology, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Munda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Keziban Uyanik-Ünal
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gottfried Novacek
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Erika Garner-Spitzer
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Winkler
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Gottfried F Fischer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Judith H Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Leonhard X Heinz
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
| | - Michael Bonelli
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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11
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Solid Organ Rejection following SARS-CoV-2 Vaccination or COVID-19 Infection: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10081289. [PMID: 36016180 PMCID: PMC9412452 DOI: 10.3390/vaccines10081289] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection is extremely rare but can occur. T-cell recognition of antigen is the primary and central event that leads to the cascade of events that result in rejection of a transplanted organ. Objectives: To describe the results of a systematic review for solid organ rejections following SARS-CoV-2 vaccination or COVID-19 infection. Methods: For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines for studies on the incidence of solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection, published from 1 December 2019 to 31 May 2022, with English language restriction. Results: One hundred thirty-six cases from fifty-two articles were included in the qualitative synthesis of this systematic review (56 solid organs rejected post-SARS-CoV-2 vaccination and 40 solid organs rejected following COVID-19 infection). Cornea rejection (44 cases) was the most frequent organ observed post-SARS-CoV-2 vaccination and following COVID-19 infection, followed by kidney rejection (36 cases), liver rejection (12 cases), lung rejection (2 cases), heart rejection (1 case) and pancreas rejection (1 case). The median or mean patient age ranged from 23 to 94 years across the studies. The majority of the patients were male (n = 51, 53.1%) and were of White (Caucasian) (n = 51, 53.7%) and Hispanic (n = 15, 15.8%) ethnicity. A total of fifty-six solid organ rejections were reported post-SARS-CoV-2 vaccination [Pfizer-BioNTech (n = 31), Moderna (n = 14), Oxford Uni-AstraZeneca (n = 10) and Sinovac-CoronaVac (n = 1)]. The median time from SARS-CoV-2 vaccination to organ rejection was 13.5 h (IQR, 3.2–17.2), while the median time from COVID-19 infection to organ rejection was 14 h (IQR, 5–21). Most patients were easily treated without any serious complications, recovered and did not require long-term allograft rejection therapy [graft success (n = 70, 85.4%), graft failure (n = 12, 14.6%), survived (n = 90, 95.7%) and died (n = 4, 4.3%)]. Conclusion: The reported evidence of solid organ rejections post-SARS-CoV-2 vaccination or COIVD-19 infection should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively small in relation to the hundreds of millions of vaccinations that have occurred, and the protective benefits offered by SARS-CoV-2 vaccination far outweigh the risks.
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12
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Wijtvliet VPWM, Verheyden S, Depreter B, Heylen C, Coeman E, Abrams S, De Winter BY, Massart A, Hellemans R, Pipeleers L, Claas FHJ, Ariën KK, Wissing KM, Abramowicz D, Ledeganck KJ. SARS-CoV-2 mRNA vaccination is not associated with the induction of anti-HLA or non-HLA antibodies. Transpl Immunol 2022; 74:101670. [PMID: 35835296 PMCID: PMC9271456 DOI: 10.1016/j.trim.2022.101670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND SARS-CoV-2 vaccination is strongly recommended in kidney transplant recipients (KTR) and dialysis patients. Whether these vaccinations may trigger alloantibodies, is still debated. METHODS In the current study we evaluated the effect of SARS-CoV-2 mRNA vaccines on anti-Human Leukocyte Antigen (HLA) and 60 anti-non-HLA antibody profiles in clinically stable KTR and dialysis patients. In total, we included 28 KTR, 30 patients on haemodialysis, 25 patients on peritoneal dialysis and 31 controls with a positive seroresponse 16-21 days after the first dose of either the SARS-CoV-2 mRNA BNT162b2 or mRNA-1273 vaccine. Both anti-HLA and anti-non-HLA antibodies were determined prior to vaccination and 21 to 35 days after the second vaccine dose. RESULTS Overall, the proportion of patients with detectable anti-HLA antibodies was similar before and after vaccination (class I 14% vs. 16%, p = 0.48; class II 25% before and after vaccination). After vaccination, there was no pattern in 1) additionally detected anti-HLA antibodies, or 2) the levels of pre-existing ones. Additional anti-non-HLA antibodies were detected in 30% of the patients, ranging from 1 to 5 new anti-non-HLA antibodies per patient. However, the clinical significance of anti-non-HLA antibodies is still a matter of debate. To date, only a significant association has been found for anti-non-HLA ARHGDIB antibodies and long-term kidney graft loss. No additionally developed anti-ARHGDIB antibodies or elevated level of existing anti-ARHGDIB antibodies was observed. CONCLUSION The current data indicate that SARS-CoV-2 mRNA vaccination does not induce anti-HLA or anti-non-HLA antibodies, corroborating the importance of vaccinating KTR and dialysis patients.
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Affiliation(s)
- Veerle P W M Wijtvliet
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium; Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium.
| | - Sonja Verheyden
- Department of Hematology, HLA and Molecular Hematology Laboratory, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Barbara Depreter
- Department of Hematology, HLA and Molecular Hematology Laboratory, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | | | | | - Steven Abrams
- Department of Family Medicine and Population Health, Global Health Institute, University of Antwerp, Antwerp, Belgium; I-BioStat, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium
| | - Annick Massart
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium; Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Rachel Hellemans
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium; Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Lissa Pipeleers
- Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Frans H J Claas
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium; Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Karl Martin Wissing
- Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Abramowicz
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium; Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium
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13
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Kim JK, Bae H, Ko GY, Lee J, Jung J, Jekarl DW, Choi AR, Lee S, Chung BH, Yang CW, Park SC, Oh EJ. 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. HLA 2022; 100:52-58. [PMID: 35484951 DOI: 10.1111/tan.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
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 ABO-incompatible kidney transplantation (ABOi KT), DSAs (anti-A24, anti-B51, 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 two months after KT. COVID-19 vaccination might relate to alloimmunization in transplant candidates, and desensitization through immune monitoring can help guide transplantation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jae Kwon Kim
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunjoo Bae
- Department of Biomedical Science, Graduate School, the Catholic University of Korea, Seoul, Korea
| | - Geon Young Ko
- Department of Biomedical Science, Graduate School, the Catholic University of Korea, Seoul, Korea
| | - Jihyun Lee
- Department of Biomedical Science, Graduate School, the Catholic University of Korea, Seoul, Korea
| | - Jin Jung
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Research and Development Institute for In Vitro Diagnostic Medical Devices of Catholic University of Korea, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Wook Jekarl
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Research and Development Institute for In Vitro Diagnostic Medical Devices of Catholic University of Korea, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ae-Ran Choi
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sangyoon Lee
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Cheol Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Research and Development Institute for In Vitro Diagnostic Medical Devices of Catholic University of Korea, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Schuller M, Pfeifer V, Kirsch AH, Klötzer KA, Mooslechner AA, Rosenkranz AR, Stiegler P, Schemmer P, Sourij H, Eller P, Prietl B, Eller K. B Cell Composition Is Altered After Kidney Transplantation and Transitional B Cells Correlate With SARS-CoV-2 Vaccination Response. Front Med (Lausanne) 2022; 9:818882. [PMID: 35187002 PMCID: PMC8847739 DOI: 10.3389/fmed.2022.818882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has major implications on kidney transplant recipients (KTRs) since they show increased mortality due to impaired immune responses to SARS-CoV-2 infection and a reduced efficacy of SARS-CoV-2 vaccination. Surprisingly, dialysis patients have shown superior seroconversion rates after vaccination compared to KTRs. Therefore, we investigated peripheral blood B cell (BC) composition before and after kidney transplantation (KT) and aimed to screen the BC compartment to explain impaired antibody generation. Methods A total of 105 patients were recruited, and multicolor flow cytometric phenotyping of peripheral venous blood BC subpopulations was performed before and 1 year after KT. Complete follow-up was available for 71 individuals. Anti-SARS-CoV-2 antibodies were collected retrospectively and were available for 40 subjects, who had received two doses of an mRNA-based vaccine (BNT162b2 or mRNA-1273). Results Overall, relative BC frequencies within lymphocytes decreased, and their absolute counts trended in the same direction 1 year after KT as compared to CKD G5 patients. Frequencies and absolute numbers of naïve BCs remained stable. Frequencies of double negative BCs, a heterogeneous subpopulation of antigen experienced BCs lacking CD27 expression, were increased after KT, yet their absolute counts were similar at both time points. Transitional BCs (TrBCs) and plasmablasts were significantly reduced after KT in absolute and relative terms. Memory BCs were affected differently since class-switched and IgM-only subsets decreased after KT, but unswitched and IgD-only memory BCs remained unchanged. CD86+ and CD5+ expression on BCs was downregulated after KT. Correlational analysis revealed that TrBCs were the only subset to correlate with titer levels after SARS-CoV-2 vaccination. Responders showed higher TrBCs, both absolute and relative, than non-responders. Conclusion Together, after 1 year, KTRs showed persistent and profound compositional changes within the BC compartment. Low TrBCs, 1 year after KT, may account for the low serological response to SARS-CoV-2 vaccination in KTRs compared to dialysis patients. Our findings need confirmation in further studies as they may guide vaccination strategies.
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Affiliation(s)
- Max Schuller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Verena Pfeifer
- Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria.,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander H Kirsch
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Konstantin A Klötzer
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Agnes A Mooslechner
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Barbara Prietl
- Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria.,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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15
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Abu-Khader A, Wang W, Berka M, Galaszkiewicz I, Khan F, Berka N. SARS Cov-2 vaccination induces de novo donor-specific HLA antibodies in a renal transplant patient on waiting list: A case report. HLA 2021; 99:25-30. [PMID: 34791833 PMCID: PMC8661878 DOI: 10.1111/tan.14492] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 01/11/2023]
Abstract
The ability of COVID‐19 vaccination to induce anti‐HLA antibodies (Abs) formation in renal transplant candidates is not well studied. A 42‐year‐old man on a renal transplant waitlist, with no sensitization history, was tested for DSA before and after COVID‐19 vaccination. Patient has consistently tested negative for COVID‐19 virus. Eighteen days after receiving first dose of mRNA‐based vaccine, flow cytometry crossmatch (FCXM) was strongly positive with de novo donor‐specific Ab (dnDSA) against B57 and de novo non‐DSA against B58. Before vaccination, preliminary FCXM was negative with no anti‐HLA Abs. This event prompted the transplant team to cancel the surgery. COVID‐19 vaccination could be associated with anti‐HLA Abs formation in renal patients on waitlists that could affect future transplantability.
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Affiliation(s)
- Ahmad Abu-Khader
- Histocompatibility and Immunogenetics Laboratory, Alberta Precision Laboratories, Alberta, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
| | - Wenjie Wang
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Meriam Berka
- Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
| | - Iwona Galaszkiewicz
- Histocompatibility and Immunogenetics Laboratory, Alberta Precision Laboratories, Alberta, Canada
| | - Faisal Khan
- Histocompatibility and Immunogenetics Laboratory, Alberta Precision Laboratories, Alberta, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
| | - Noureddine Berka
- Histocompatibility and Immunogenetics Laboratory, Alberta Precision Laboratories, Alberta, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
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