{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T12:52:11Z","timestamp":1769345531444,"version":"3.49.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In renal transplant waitlisted patients, vaccinations remain the standard of care for infection prevention. The vaccine and its adjuvant sensitizer can be potential sources for the induction of donor-specific antibodies (DSA) against human leukocyte antigens (HLA). These novel HLA antibodies can result in a positive flow cell crossmatch (FCXM), which can make a previously compatible live donor incompatible.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report<\/jats:title><jats:p>We present an adult renal transplant waitlisted patient who has had multiple negative T-cell and B-cell FCXM with no detection of DSA at baseline. The patient then received a single dose of pneumococcal conjugate (PCV13) and a second dose of recombinant zoster vaccine (RZV). After these vaccinations, the patient\u2019s FCXM was positive for both T-cells and B-cells and the HLA class I antibodies (A1, 23, 24, 80; B44, 45, 76) showed a calculated panel reactive antibody (cPRA) of 51%. A1 and B44 DSA were detected which predicted incompatibility with the patient\u2019s planned live donor renal transplant. The patient had to enter the kidney-paired donation program instead and receive their transplantation after 16 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>RZV or PCV13 vaccines or their adjuvant components can potentially cause allosensitization in renal transplant waitlisted patients. The detection of DSA can result in reduced access to compatible transplants. With advances in HLA immunogenetics, better tools can monitor HLA-specific memory B-cells to provide crucial insights into the primary mechanism of action of HLA DSA antibody formation and suggest interventions to mitigate this memory B-cell activation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1567377","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T07:09:34Z","timestamp":1741936174000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Vaccine-induced donor-specific HLA antibodies: a case report highlighting sensitization risks in renal transplant waitlisted patients"],"prefix":"10.3389","volume":"16","author":[{"given":"Pramath","family":"Kakodkar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nooshin","family":"Shekari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Mainra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Destinie","family":"Webster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Twyla","family":"Pearce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Mostafa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00950208","article-title":"Aspects of immune dysfunction in end-stage renal disease","volume":"3","author":"Kato","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.4103\/0971-4065.181294","article-title":"Overall immune profile and effect of chronic kidney disease on vaccination schedule","volume":"26","year":"2016","journal-title":"Indian J Nephrol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003137","article-title":"Summary of the kidney disease: improving global outcomes (KDIGO) clinical practice guideline on the evaluation and management of candidates for kidney transplantation","volume":"104","author":"Chadban","year":"2020","journal-title":"Transplantation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1093\/cid\/cit684","article-title":"2013 IDSA clinical practice guideline for vaccination of the immunocompromised host","volume":"58","author":"Rubin","year":"2014","journal-title":"Clin Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15097","article-title":"Usefulness of a systematic approach at listing for vaccine prevention in solid organ transplant candidates","volume":"19","author":"Blanchard-Rohner","year":"2019","journal-title":"Am J Transplant"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2018.03.001","article-title":"Does vaccination in solid-organ\u00a0transplant recipients result in adverse immunologic sequelae? A systematic review and meta-analysis","volume":"37","author":"Mulley","year":"2018","journal-title":"J Heart Lung Transplant"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01917","article-title":"Effect of influenza vaccination inducing antibody mediated rejection in solid organ transplant recipients","volume":"11","author":"Cordero","year":"2020","journal-title":"Front Immunol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3390\/vaccines7030084","article-title":"Sex-specific differences in HLA antibodies after pneumococcal vaccination in kidney transplant recipients","volume":"7","author":"Lindemann","year":"2019","journal-title":"Vaccines (Basel)"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2023-0370-OA","article-title":"The interplay between\u00a0human leukocyte antigen antibody profile and COVID-19 vaccination in waitlisted renal transplant patients","volume":"149","author":"Zhao","year":"2025","journal-title":"Arch Pathol Lab Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"25151355211059791","DOI":"10.1177\/25151355211059791","article-title":"Comprehensive literature review on COVID-19 vaccines and role of SARS-CoV-2 variants in the\u00a0pandemic","volume":"9","author":"Yap","year":"2021","journal-title":"Ther Adv Vaccines Immunother"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16753","article-title":"Positive flow cytometry crossmatch with discrepant antibody testing results following COVID-19 vaccination","volume":"21","author":"Xu","year":"2021","journal-title":"Am J Transplantation"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2020.10.050","article-title":"Chronic active antibody-mediated rejection following COVID-19 infection in a kidney transplant recipient: A case report","volume":"53","author":"Abuzeineh","year":"2021","journal-title":"Transplant Proc"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit365","article-title":"Safety\u00a0and immunogenicity of an AS01-adjuvanted varicella-zoster virus subunit candidate vaccine against herpes zoster in adults >=50 years of age","volume":"208","author":"Chlibek","year":"2013","journal-title":"J Infect Dis"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000724","article-title":"Detecting the humoral alloimmune response: we need more than serum antibody screening","volume":"99","author":"Karahan","year":"2015","journal-title":"Transplantation"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.390","article-title":"Restricted specificity of peripheral alloreactive memory B cells in HLA-sensitized patients awaiting a kidney transplant","volume":"87","author":"Snanoudj","year":"2015","journal-title":"Kidney Int"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-07-234906","article-title":"Allo-HLA reactivity of virus-specific memory T cells is common","volume":"115","author":"Amir","year":"2010","journal-title":"Blood"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.trim.2010.06.008","article-title":"Alloreactivity from human viral specific memory T-cells","volume":"23","author":"D\u2019Orsogna","year":"2010","journal-title":"Transpl Immunol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14279","article-title":"Allo-HLA cross-reactivities of cytomegalovirus-, influenza-, and varicella zoster virus\u2013specific memory T cells are shared by different healthy individuals","volume":"17","author":"van den Heuvel","year":"2017","journal-title":"Am J Transplantation"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2018.08.069","article-title":"Pneumococcal vaccination in adult solid organ transplant recipients: A review of current evidence","volume":"36","author":"Dendle","year":"2018","journal-title":"Vaccine"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/tid.2018.20.issue-2","article-title":"Seroresponses and safety of 13-valent pneumococcal conjugate vaccination in kidney transplant recipients","volume":"20","author":"Dendle","year":"2018","journal-title":"Transpl Infect Dis"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2013.04.085","article-title":"Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults","volume":"31","author":"Jackson","year":"2013","journal-title":"Vaccine"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1007\/s00251-017-0989-3","article-title":"Infectious pathogens may trigger specific allo-HLA reactivity via multiple mechanisms","volume":"69","author":"D\u2019Orsogna","year":"2017","journal-title":"Immunogenetics"},{"key":"B23","unstructured":"2024"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-014-2868-6","article-title":"HLA sensitisation: can it be prevented","volume":"30","author":"Rees","year":"2015","journal-title":"Pediatr Nephrol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-014-2823-6","article-title":"Washing red cells after leucodepletion does not decrease human leukocyte antigen sensitization risk in patients with chronic kidney disease","volume":"29","author":"Aston","year":"2014","journal-title":"Pediatr Nephrol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqae129.217","article-title":"Case Report: Emergence of de novo Donor-Specific HLA antibodies post Pneumococcal & Varicella Zoster Vaccinations in Waitlisted Renal Transplant Candidate","volume":"162","author":"Kakodkar","year":"2024","journal-title":"Am J Clin Pathol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1567377\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T07:09:37Z","timestamp":1741936177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1567377\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,14]]},"references-count":26,"alternative-id":["10.3389\/fimmu.2025.1567377"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1567377","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,14]]},"article-number":"1567377"}}