title: Rapid and strong de novo donor-specific antibody development in a lung transplant recipient: Short communication/case report.
abstract: A 66-yo female patient (typed B*39:01, 44:02) underwent first left single lung transplant (typed B*81:01, 15:17) on 02/07/2016 with negative for DSA in current and historical samples. On 02/17/2016 strong de novo DSA (MFI=15,200, C1q+) to B81 were detected. The recipient has two children typed B*07:02, 44:02 B*27:03, 39:01, and had received multiple vaccinations. Twinrix, Zostavax and MMR vaccines contain viruses grown on live human lung fibroblasts (MRC-5, typed B*07:02, 44:02, and WI-38, typed B*08:01, 58:01). Each dose of vaccine used for injection is known to contain protein components of fibroblasts including HLA. Most likely rapid de novo DSA development is due to booster effect produced by five exposures to mismatched B locus alleles which share the following epitopes: 70IAQ, 65QIA, 65QIA+76esn, 69aa+80n, and 163ew+73te. The later three consist of paired non-self and self eplets. Although likelihood of bystander effect produced by multiple vaccinations is low its impact cannot be ruled out.
authors.affiliation: Indiana University Health, Methodist Hospital, Histocompatibility Laboratory, USA. Electronic address: alobashe@iu.edu.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Lobashevsky
authors.affiliation: Indiana University Health, Methodist Hospital, Histocompatibility Laboratory, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Rosner
authors.affiliation: Indiana University Health, Methodist Hospital, Histocompatibility Laboratory, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: May
authors.affiliation: Indiana University Health Thoracic Transplant, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Duncan
authors.affiliation: Indiana University Health Thoracic Transplant, USA.
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Hage
authors.affiliation: Indiana University Health Thoracic Transplant Pharmacy, Indianapolis, IN 46202, USA.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Lushin
authors.affiliation: Indiana University Health Thoracic Transplant Pharmacy, Indianapolis, IN 46202, USA.
authors.forename: Eve E
authors.initials: EE
authors.lastname: Anderson
authors.affiliation: Indiana University Health Thoracic Transplant, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Roe
mesh_terms: D000368:Aged; D001324:Autoantigens / Q000276:immunology*; D003429:Cross Reactions; D018985:Epitopes, B-Lymphocyte / Q000276:immunology*; D005260:Female; D020073:Gravidity / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D064789:Immunity, Heterologous; D056724:Immunity, Humoral; D007114:Immunization; D007519:Isoantigens / Q000276:immunology; D016040:Lung Transplantation; D011247:Pregnancy; D014184:Transplantation, Homologous; D014611:Vaccination; D014612:Vaccines / Q000276:immunology*
chemical_list: D001324:Autoantigens; D018985:Epitopes, B-Lymphocyte; D015235:HLA-B Antigens; D007519:Isoantigens; D014612:Vaccines
keywords: Antibodies; Epitope; HLA; Vaccination