AUTHOR=Cordero Elisa , Bulnes-Ramos Angel , Aguilar-Guisado Manuela , González Escribano Francisca , Olivas Israel , Torre-Cisneros Julián , Gavaldá Joan , Aydillo Teresa , Moreno Asunción , Montejo Miguel , Fariñas María Carmen , Carratalá Jordi , Muñoz Patricia , Blanes Marino , Fortún Jesús , Suárez-Benjumea Alejandro , López-Medrano Francisco , Roca Cristina , Lara Rosario , Pérez-Romero Pilar 

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

JOURNAL=Frontiers in Immunology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2020.01917

DOI=10.3389/fimmu.2020.01917

ISSN=1664-3224

ABSTRACT=Introduction. Our goal was to study whether influenza vaccination induce alloreactivity associated with 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™ 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 influenza vaccination from 2009-2013: 110 (22.4%) the pandemic adjuvanted vaccine, 59 (12%) within the first six months post-transplantation, 185 (37.7%) more than six 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 six months post-transplantation, or based on the type of organ transplanted. However, the second immunization dose increased significantly the percentage of patients positive for anti-HLA class I 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 of graft rejection with favorable outcomes and neither of them developed DSA. 
Conclusions. Our results suggest that influenza vaccination is not associated with graft rejection in this cohort of SOTR.