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Influenza Vaccination and de novo Donor Specific Antibody (DSA) in Lung Transplant Recipient: Is There a Causal Relationship?
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A4737 - Influenza Vaccination and de novo Donor Specific Antibody (DSA) in Lung Transplant Recipient: Is There a Causal Relationship?
Author Block: T. Thaniyavarn, L. D. Snyder, H. A. Ali; Pulmonary and Critical Care Medicine, Duke University Hospital, Durham, NC, United States.
Introduction: There is a theoretical concern that inactivated influenza vaccination (IIV) may be associated with de novo DSA generation through heterologous immunity. However, the data in lung transplant is limited. Here we describe our single-center experience with lung transplant patients who received IIV after transplant prior to detection of de novo DSA. Methods: Lung transplant recipients at Duke University who had a post-transplant IIV and subsequently developed a de novo DSA to human leukocyte antigen (HLA) between January 2015 and December 2016 were included. We excluded patients with multiorgan or redo lung transplant. We considered changes by Wilcoxon signed rank sum test in calculated panel reactive antibody (cPRA) before and after the IIV as a measure of potential humoral activation. Furthermore, we analyzed the time from IIV to DSA appearance. Results: 62 patients with de novo DSA post-transplant were identified. After excluding multiorgan and re-transplant, there were 53 patients and of these, 22 received IIV after transplant and prior to DSA. In this cohort, the median time from last vaccination to development of DSA was 175 days (IQR 139- 283). There is no difference in mean HLA class I cPRA between pre-and 3 months post vaccination, 8.41 and 7.41 (p= 0.62) respectively. There was a significant difference between pre-and 3 months post vaccination mean HLA class II cPRA, 4.18 and 16.18 (p=0.0078) respectively. Of those who had increased in class II cPRA, the median time from IIV to DSA detection was 179 days, all of which were class II DSA. Conclusions: Median time to DSA From IIV is 175 days, suggesting that DSA development is outside of the window (90 days) to be related to IIV. However, there is an increase in HLA class II cPRA in the 3 months after IIV, which indicated future larger studies are needed.
Author Block: T. Thaniyavarn, L. D. Snyder, H. A. Ali; Pulmonary and Critical Care Medicine, Duke University Hospital, Durham, NC, United States.
Introduction: There is a theoretical concern that inactivated influenza vaccination (IIV) may be associated with de novo DSA generation through heterologous immunity. However, the data in lung transplant is limited. Here we describe our single-center experience with lung transplant patients who received IIV after transplant prior to detection of de novo DSA. Methods: Lung transplant recipients at Duke University who had a post-transplant IIV and subsequently developed a de novo DSA to human leukocyte antigen (HLA) between January 2015 and December 2016 were included. We excluded patients with multiorgan or redo lung transplant. We considered changes by Wilcoxon signed rank sum test in calculated panel reactive antibody (cPRA) before and after the IIV as a measure of potential humoral activation. Furthermore, we analyzed the time from IIV to DSA appearance. Results: 62 patients with de novo DSA post-transplant were identified. After excluding multiorgan and re-transplant, there were 53 patients and of these, 22 received IIV after transplant and prior to DSA. In this cohort, the median time from last vaccination to development of DSA was 175 days (IQR 139- 283). There is no difference in mean HLA class I cPRA between pre-and 3 months post vaccination, 8.41 and 7.41 (p= 0.62) respectively. There was a significant difference between pre-and 3 months post vaccination mean HLA class II cPRA, 4.18 and 16.18 (p=0.0078) respectively. Of those who had increased in class II cPRA, the median time from IIV to DSA detection was 179 days, all of which were class II DSA. Conclusions: Median time to DSA From IIV is 175 days, suggesting that DSA development is outside of the window (90 days) to be related to IIV. However, there is an increase in HLA class II cPRA in the 3 months after IIV, which indicated future larger studies are needed.
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