Yellow Fever and Renal Transplantation: Influence of Vaccination and Infection on the Emergence of Antibody-Mediated Rejection
1Department of Internal Medicine - Division of Nephrology, University of Campinas, Campinas, Brazil, 2Department of Internal Medicine, University of Campinas, Campinas, Brazil, 3Department of Internal Medicine - Division of Infectious Diseases, University of Campinas, Campinas, Brazil, 4Surgery Department, University of Campinas, Campinas, Brazil
Meeting: 2019 American Transplant Congress
Abstract number: D92
Keywords: HLA antibodies, Infection, Rejection, Vaccination
Session Information
Session Name: Poster Session D: Kidney Acute Antibody Mediated Rejection
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Yellow fever (YF) is a viral hemorrhagic disease transmitted by mosquitos, with variable clinical disease manifestations from a mild, undifferentiated febrile illness to severe disease with jaundice and hemorrhagic manifestations. The yellow fever vaccine (YFV) is a live vaccine that produces a high level of protection against YF. The incidence of side effects of YFV in transplanted patients is unknown. Live vaccines such YFV are contraindicated in patients receiving immunosuppressive treatment, and should be administered during the pre-transplant period.
*Methods: Case report and literature review about influence of yellow fever vaccination and infection on the emergence of antibody-mediated rejection in renal transplantation.
*Results: Case: a 50 years old male, recipient of a deceased kidney transplant 5 years ago. One day after YFV, patient was admitted at emergency unit with nausea, vomiting, fever, diarrhea and non-migratory polyarthralgia of large joints, thrombocytopenia and increased levels of aspartate aminotransferase and alanine aminotransferase. Serological result and quantitative real time polymerase chain reaction (RT-PCR) confirmed the diagnosis of wild-type yellow fever. The patient remained under supportive care for twelve days, with hospital discharge in good clinical condition and stable renal function. One month after discharge, patient developed de novo donor specific anti-HLA antibodies, class I and II, (A36, DQB1-2 and DQB1-03, sum MFI 56,686) and histological evidence of endothelial lesion, with a diagnosis of acute antibody mediated rejection, treated wiht plasmapheresis and human IVIg therapy. After treatment, renal function was preserved (serum creatinine 0.9 mg/dL ) with reduction of donor specific anti-HLA antibodies (DSA) immunofluorescence intensity.
*Conclusions: Live vaccines such as YF are contraindicated in patients receiving immunosuppressive treatment, due to the risk of developing the disease after vaccination. In the present case we observed a clinical wild-type YF after vaccine. Time course of AMR after YF disease and vaccine could be related to the immunological stimulation by the vaccine components or by the changes in immunosuppression associated with the disease.
To cite this abstract in AMA style:
Sousa MV, Zollner RL, Stucchi RS, Boin IF, Ataide EC, Mazzali M. Yellow Fever and Renal Transplantation: Influence of Vaccination and Infection on the Emergence of Antibody-Mediated Rejection [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/yellow-fever-and-renal-transplantation-influence-of-vaccination-and-infection-on-the-emergence-of-antibody-mediated-rejection/. Accessed May 9, 2025.« Back to 2019 American Transplant Congress