Vaccine-Induced Coronay Antibodie-Mediated Rejection and Thrombosis in a Heart Transplant Pacient: A Case Report

INTRODUCTION: Heart tansplant (HT) recipients constitute a population at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Efficay and safety of SARS-CoV-2 vaccine in this population is still yet to be established. It has been described, immune thrombotic thrombocytopenia, myocarditis and Guillain-Barre syndrome in individuals who received the ChAdOx1 SARS-CoV-2 vaccine. There are very few cases of acute rejection after SARS-CoV-2 vaccination post HT patients. We will describe a several outcome of heart function vaccine-induced. CASE REPORT: A 46-year-old heart transplanted male since 2015, started with persistent cough 15 days after a dose of adenoviral vector-based vaccine against SARS-CoV-2. As he had increased troponin and new left ventricular dysfunction, he underwent an endomyocardial biopsy, collected an panel reactive antibodies (PRA) and started pulse dose metylprednisolone. He developed an ischemic electrocardiographic alteration with a ST elevation and the coronary angiography found a thrombosis in the anterior descending coronary artery with no success with percutaneous treatment. Endomyocardial biopsy found no acute rejection, and PRA showed de novo donor specific antibodies (DSA). Despite treatment for antibodie-mediated rejection with plasmapheresis, human immunoglobulin and rituximab, he had a cardiogenic shock, refractory to inotropic support and intra-aortic balloon pump, requiring peripheral VA ECMO. Regardless of initial hemodynamic response and partial recovery of biventricular function, patient could not stand weaning from ECMO and inotropes. After rejection therapy, PRA showed no antibodies and patient was included in HT list and had a retransplant after 16 days without complications. SUMMARY: To the best of our knowledge, this is the firts report of antibodie-mediated rejection in heart-transplant patient with thrombotic complication after ChAdOx1 SARS-CoV-2 vaccine. Although vaccination remains the main approach of preventing SARS-CoV-2 infeccion, transplant recipients were not included in clinical trials, so its safety remains unknown in this population. More studies are needed in order to increase knowledge about vaccine outcomes in these individuals.