A 54 year old African American female with 4 previous pregnancies received a kidney transplant from a living non related donor in November, 2001. Anti-HLA antibodies were not detected by Flow Cytometry cross matches (FCXM) that were negative at the time of the 2001 transplant. The patient’s transplanted kidney failed in Aug 2014 due to chronic rejection and the patient underwent a nephrectomy. At that time donor specific antibody (DSA) against the HLA of the first donor was not detected. The patient was subsequently XM against her daughter in November, 2014. Anti-HLA antibody using screening beads/Luminex technology was not detected and the FCXM was negative. The patient received Hepatitis A and B vaccinations in November, 2014 followed by two subsequent vaccinations in January and March of 2015 (with seroconversion). In February 2015, anti-HLA antibody was detected on routine screen and DSA was detected by single antigen bead (SAB) assays against a Class 1 HLA in common with the first and second donor (the daughter). No other identifiable sensitizing events, e.g., infection or blood transfusion were noted. The patient received 9 plasmapheresis treatments, QOD and IVIG. SAB tests indicated a reduction in DSA during the course of therapy. DSA was not detected after the 8th plasmapheresis treatment and the FCXM was negative. The patient received a kidney transplant 2 days later. Her creatinine came down from 9.9 mg/dl at transplant to an average of 1.35 mg/dl at 3–4 weeks after surgery. Conclusions and recommendations: These results suggest that caution should be exercised when considering vaccination of a previously transplanted patient even when the patient has not developed anti-HLA antibodies to potential recall antigens. Frequent anti-HLA antibody detection assays should be performed following vaccination to avoid unexpected positive XMs. Sensitization by viral vaccines may be overcome by standard desensitization protocols that are in current use.