Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun;29(4):e70084.
doi: 10.1111/petr.70084.

Low Incidence of Rejection and De Novo Donor-Specific Antibody Formation Following COVID-19 Vaccination or Infection Among Pediatric Kidney Transplant Recipients

Helen Pizzo  1 , Jonathan Garrison  1 , Kelly Kirshner  1 , Dechu Puliyanda  1
Affiliations

Low Incidence of Rejection and De Novo Donor-Specific Antibody Formation Following COVID-19 Vaccination or Infection Among Pediatric Kidney Transplant Recipients

Helen Pizzo et al. Pediatr Transplant. 2025 Jun.

Abstract

Background: Studies in adults have demonstrated a risk for allograft rejection or development of donor-specific antibodies (DSA) following SARS-CoV-2 vaccination. We examined the incidence of acute rejection and de novo DSA following COVID-19 vaccination or infection among pediatric kidney transplant patients.

Method: Retrospective analysis of 23 pediatric kidney transplant recipients without prior history of rejection, DSA, or COVID-19 infection who received the SARS-CoV-2 mRNA vaccine. Risk for rejection was evaluated via monitoring of serum creatinine, DSA, and donor-derived cell-free DNA per center protocol. Results concerning for rejection prompted allograft biopsy, graded by the Banff classification system.

Results: Eight of 23 (34.8%) received two doses of SARS-CoV-2 mRNA vaccine, 15 (65.3%) received three doses. Two (8.7%) had rejection; one with de novo DSA, another without. There was no difference in the number of doses of COVID-19 vaccine received in those with rejection vs. no rejection (p = 0.53). 13 (56.5%) developed SARS-CoV-2 infection, with no difference in the number of vaccines received between those infected with COVID-19 vs. those who were not (p = 0.69). No adjustments were made to the maintenance immunosuppression during SARS-CoV-2 infection, and there was no evidence of rejection or DSA formation after infection. Median follow-up time was 29.9 months (IQR 25.0-33.4 months) after the first vaccine dose.

Conclusion: In our small single-center cohort, SARS-CoV-2 vaccination or infection is unlikely to increase the risk for rejection or de novo DSA in pediatric kidney transplant recipients. Larger prospective studies with a control group are needed to further understand the immune effects of the COVID-19 vaccine and disease in this population.

Keywords: acute rejection; anti‐HLA antibody; children; graft rejection; immune responses; pediatric renal transplantation.

PubMed Disclaimer

References

    1. A. B. Massie, W. A. Werbel, R. K. Avery, T. Po‐Yu Chiang, J. J. Snyder, and D. L. Segev, “Quantifying Excess Deaths Among Solid Organ Transplant Recipients in the COVID‐19 Era,” American Journal of Transplantation 22, no. 8 (2022): 2077–2082.
    1. S. Caillard, N. Chavarot, H. Francois, et al., “Is COVID‐19 Infection More Severe in Kidney Transplant Recipients?,” American Journal of Transplantation 21, no. 3 (2021): 1295–1303.
    1. J. Korth, M. Jahn, O. Dorsch, et al., “Impaired Humoral Response in Renal Transplant Recipients to SARS‐CoV‐2 Vaccination With BNT162b2 (Pfizer‐BioNTech),” Viruses 13, no. 5 (2021): 756.
    1. G. Russo, Q. Lai, L. Poli, et al., “SARS‐COV‐2 Vaccination With BNT162B2 in Renal Transplant Patients: Risk Factors for Impaired Response and Immunological Implications,” Clinical Transplantation 36, no. 1 (2022): e14495.
    1. B. Rozen‐Zvi, D. Yahav, T. Agur, et al., “Antibody Response to SARS‐CoV‐2 mRNA Vaccine Among Kidney Transplant Recipients: A Prospective Cohort Study,” Clinical Microbiology and Infection 27, no. 8 (2021): 1173.

Substances

Grants and funding