Balancing B cell responses to the allograft: implications for vaccination

Balancing enough immunosuppression to prevent allograft rejection and yet maintaining an intact immune system to respond to vaccinations, eliminate invading pathogens or cancer cells is an ongoing challenge to transplant physicians. Antibody mediated allograft rejection remains problematic in kidney transplantation and is the most common cause of graft loss despite current immunosuppressive therapies. The goal of immunosuppressive therapies is to prevent graft rejection; however, they prevent optimal vaccine responses as well. At the center of acute and chronic antibody mediated rejection and vaccine responses is the B lymphocyte. This review will highlight the role of B cells in alloimmune responses including the dependency on T cells for antibody production. We will discuss the need to improve vaccination rates in transplant recipients and present data on B cell populations and SARS-CoV-2 vaccine response rates in pediatric kidney transplant recipients.

Automated summary

Finding a balance between immunosuppression and immune response is a challenge in transplant medicine. Antibody mediated allograft rejection remains a common problem in kidney transplantation despite current therapies. B lymphocytes play a crucial role in alloimmune responses and vaccine efficacy. Improving vaccination rates in transplant recipients is important, and data on B cell populations and SARS-CoV-2 vaccine response in pediatric kidney transplant recipients will be discussed.