Effect of Influenza Vaccination Inducing Antibody Mediated Rejection in Solid Organ Transplant Recipients

Abstract

Introduction: Our goal was to study whether influenza vaccination induced antibody mediated rejection in a large cohort of solid organ transplant recipients (SOTR).

Methods: Serum anti-Human Leukocyte Antigen (HLA) antibodies were determined using class I and class II antibody-coated latex beads (FlowPRA^TM Screening Test) by flow cytometry. Anti-HLA antibody specificity was determined using the single-antigen bead flow cytometry (SAFC) assay and assignation of donor specific antibodies (DSA) was performed by virtual-crossmatch.

Results: We studied a cohort of 490 SOTR that received an influenza vaccination from 2009 to 2013: 110 (22.4%) received the pandemic adjuvanted vaccine, 59 (12%) within the first 6 months post-transplantation, 185 (37.7%) more than 6 months after transplantation and 136 (27.7%) received two vaccination doses. Overall, no differences of anti-HLA antibodies were found after immunization in patients that received the adjuvanted vaccine, within the first 6 months post-transplantation, or based on the type of organ transplanted. However, the second immunization dose increased the percentage of patients positive for anti-HLA class I significantly compared with patients with one dose (14.6% vs. 3.8%; P = 0.003). Patients with pre-existing antibodies before vaccination (15.7% for anti-HLA class I and 15.9% for class II) did not increase reactivity after immunization. A group of 75 (14.4%) patients developed de novo anti-HLA antibodies, however, only 5 (1.02%) of them were DSA, and none experienced allograft rejection. Only two (0.4%) patients were diagnosed with graft rejection with favorable outcomes and neither of them developed DSA.

Conclusion: Our results suggest that influenza vaccination is not associated with graft rejection in this cohort of SOTR.

Keywords: alloreactivity; anti-human leukocyte antigen; cytomegalovirus; donor specific antibodies; organ rejection.

FIGURE 1

The percentage of patients that were positive for anti-HLA class I or II antibodies: (A) Before and after influenza vaccination; (B) Comparing patients receiving the adjuvanted or non-adjuvanted vaccine at the indicated time of receiving the influenza vaccine immunization; (C) Comparing patients that received the influenza vaccine within the first 6 months (<6 months) or after 6 months (>6 months) post-transplantation; (D) Comparing patients receiving one or two doses of the influenza vaccine; (E) Comparing patients based on the organ type for anti-HLA class I antibodies; (F) Comparing patients based on the organ type for anti-HLA class II antibodies. Notes: Baseline refers to the time of administration of the first dose of influenza vaccine, 5 weeks refers to 5 weeks after the first dose, 10 weeks refers to 5 weeks after the second dose and 1 year refers to 1 year after immunization.*P < 0.05, statistically significant difference.