key: cord-0739500-pb24cifz
authors: Loupy, Alexandre; Goutaudier, Valentin; Jacquelinet, Christian; Kerbaul, François
title: Solid organ procurement and transplantation from deceased donors with vaccine‐induced thrombosis and thrombocytopenia
date: 2021-07-17
journal: Am J Transplant
DOI: 10.1111/ajt.16751
sha: 30952668ab64435917cb41014d647fc03847d5c0
doc_id: 739500
cord_uid: pb24cifz

In late February 2021, the first cases of vaccine-induced thrombosis and thrombocytopenia (VITT) were observed in patients after immunization with the ChAdOx1 nCoV-19 adenoviral vector vaccine (Oxford, AstraZeneca) against SARS-CoV-2.1 This prothrombotic response is presumed to be mediated by anti-platelet factor 4 (PF4) antibodies that activate platelets and induce activation and extracellular traps formation of neutrophils.2 These antibodies can also be seen in autoimmune heparin-induced thrombocytopenia, but all the described cases had no previous exposure to heparin.

To the Editor:

In late February 2021, the first cases of vaccine-induced thrombosis and thrombocytopenia (VITT) were observed in patients after immunization with the ChAdOx1 nCoV-19 adenoviral vector vaccine (Oxford, AstraZeneca) against SARS-CoV-2. 1 This prothrombotic response is presumed to be mediated by anti-platelet factor 4 (PF4) antibodies that activate platelets and induce activation and extracellular trap formation of neutrophils. 2 These antibodies can also be seen in autoimmune heparininduced thrombocytopenia, but all the described cases had no previous exposure to heparin. 1 4 and also transmission of VITT to the recipients. 5 Here, we report the first use and outcome of solid organ transplant procured from donors who died of complications from VITT.

From April 9 up to May 7, 2021, we identified five potential deceased donors with VITT, using existing diagnostic criteria 1 with confirmation by hematologist evaluation. All the patients had received the (Table 1) .

Two organ procurement procedures were canceled (one due to family refusal and the other because of severe disseminated intravascular coagulation). Three organ procurement procedures were achieved.

During these ones, two livers were discarded because of extensive portal vein thrombosis and one lung required a thrombectomy for segmental pulmonary embolism. Finally, 10 organs (six kidneys, two hearts, one lung, and one liver) were recovered and transplanted to nine recipients, who were followed until June 21, 2021 (Table 1) . antibodies. Our analysis shows that the early outcomes of these transplants were favorable. While the presence of thrombi in a few organs suggests the possibility that organ function could be compromised if thrombosis was extensive, we were able to select organs with limited thrombi and did not find any evidence of transmission of VITT to the recipients. In conclusion, our data support that organs from deceased donors with VITT may be suitable for transplantation and should be carefully assessed, but not systematically discarded. 

Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination

Towards understanding ChAdOx1 nCov-19 Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT)

Organ procurement and transplantation during the COVID-19 pandemic

Implications of donor disseminated intravascular coagulation on kidney allograft recipients

Donors with immune thrombocytopenia: do they pose a risk to transplant recipients?