Kidney Transplantation from a Deceased Donor with COVID-19 Ad26.COV2-S Vaccine-Induced Thrombotic Thrombocytopenia

Case series Patients: Female, 65-year-old • Male, 49-year-old Final Diagnosis: Ad26.COV2-S vaccine-induced thrombotic thrombocytopenia • end stage renal disease Symptoms: ESKD • kidney infarct • pulmonary embolism • thrombocytopenia • thrombosis Clinical Procedure: Kidney transplantation Specialty: Hematology • Immunology • Transplantology • Urology OBJECTIVE: Rare disease BACKGROUND: Vaccine-induced thrombosis and thrombocytopenia is a rare immune disorder documented after adenoviral vector ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2-S (Janssen) vaccine administration against severe acute respiratory syndrome coronavirus 2. It is a rare adverse effect with an incidence of 1 case per 100 000 exposures. The disorder represents altered immune response with proliferation of antibodies that bind to platelet factor 4 (PF4), leading to formation of thrombi and consumptive coagulopathy. Thrombosis combined with thrombocytopenia generally occurs in the first month following vaccination and can lead to fatal outcome, even in young, previously healthy individuals. These young adults ultimately may become solid organ donors. The main concerns with vaccine-induced thrombosis and thrombocytopenia solid organ donors are anti-PF4 antibodies transmission potential, risk of early major graft thrombosis, and serious bleeding. CASE REPORTS: In our center, 2 kidney transplantations were performed from a single brain-dead vaccine-induced thrombosis and thrombocytopenia donor following Ad26.COV2-S COVID-19 (Janssen) vaccine in October 2021, which represents the first 2 cases of kidney transplantation from a deceased vaccine-induced thrombosis and thrombocytopenia donor after immunization with Ad26.COV2-S (Janssen) vaccine. Both recipients were closely monitored in the early post-transplantation period and after discharge from the hospital. To date, both recipients have a good functioning allograft, without any evidence of vaccine-induced thrombosis and thrombocytopenia transmission. CONCLUSIONS: Our results are consistent with those of previously published cases of successful vaccine-induced thrombosis and thrombocytopenia donor solid organ transplantation. Kidney allografts transplanted from vaccine-induced thrombosis and thrombocytopenia donors can have a good overall function with favorable outcomes.