key: cord-0915314-b3j9fl6h
authors: van Bruchem, Milou; van Rosmalen, Marieke; Warmerdam, Alex; Vos, Robin; Ceulemans, Laurens J.; van Raemdonck, Dirk; Vogelaar, Serge
title: Outcome After Organ Transplantation From Brain-dead Donors After a Cerebral Insult Following SARS-CoV-2 Vaccination Within the Eurotransplant Region
date: 2021-09-24
journal: Transplantation
DOI: 10.1097/tp.0000000000003965
sha: 25522215697a674de21835dff478c5c4c3df80b0
doc_id: 915314
cord_uid: b3j9fl6h

nan

V accine-induced thrombosis and thrombocytopenia (VITT) may occasionally occur following vaccination for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) with adenovirus vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2·S (Janssen/J&J). 1 Rarely, VITT leading to sinus venosus thrombosis may result in fatal brain death, which leads to these subjects becoming potential organ donors. Currently, data on organs transplanted from deceased VITT donors are scarce, except for data from a recent study from the United Kingdom. 2 A retrospective analysis within the Eurotransplant International Foundation (ET) 3 region was performed to investigate the incidence and possible impact of VITT in the donor on recipient outcomes.

All donors reported to ET from March 1 to June 1, 2021, who received SARS-CoV-2 vaccination were individually checked for possible VITT-related cause of death (CoD). Deceased donors with possible VITT were identified on the basis of the CoD, type of vaccination, documentation of cerebral thrombosis with or without thrombocytopenia 4-30 d after exposure to the aforementioned vaccines, 4 and suspicion of vaccine-related complications reported by the donor coordinator. Transplant centers of the organ recipients were contacted for short-term follow-up outcomes. In this 3-mo period, 511 deceased donors were reported to ET. In 60 patients (11.7%), information was available on the administration of at least 1 dose of anti-SARS-CoV-2 vaccine: 33 (55%) BioNTech Pfizer, 3 (5%) Moderna, 2 (3.3%) Sputnik V, 1 (1.7%) SinoPharm, 5 (8.3%) unknown, and 16 (26.7%) were vaccinated with AstraZeneca (15) or Janssen (1) in the period preceding organ donation. Six donors with possible VITT-related CoD were identified. This was 2.1% (6/280) of all the donors reported with a similar CoD. All donors received adenovirus-based vaccines AstraZeneca (5) or Janssen (1) at a median of 14 d (9-25 d) before admission to the intensive care unit.

These 6 donors with a median age of 48 y (37-72 y), 50% female, provided 20 organs to 17 recipients (Table 1) . After a median follow-up of 43 d (19-93 d), all recipients were alive and 19 organs (95%) were functioning well. Two recipients (11.8%) developed thrombosis-related complications; 1 kidney developed thrombotic microangiopathy but recovered completely. One split-liver recipient developed thrombotic material in different vessels and necrosis of liver cells, resulting in urgent retransplantation.

Organs from 6 deceased donors with a possible VITT were allocated through ET during a 3-mo period. As previous SARS-CoV-2 vaccination was not systematically reported for all these donors, this analysis could be an underestimation. Donor information did not include information concerning positivity for immunoglobulin G antiplatelet factor 4 antibodies. Although clinical relevance is still uncertain, this could make VITT diagnosis in donors more likely. 5 In addition, 4 deceased donors who received a BioNTech Pfizer vaccine with a reported history of thrombosis were excluded because of insufficient evidence to be VITT-related.

Overall, the outcome of our small analysis of transplanted organs from possible VITT-related donors does not seem to differ from "non-VITT donors." Nevertheless, caution is urged with these donors, and the acceptance of each organ remains to be assessed on an individual basis by the transplant team.

First and foremost, the authors would like to thank all deceased donors and their families. Second, they would like to thank the allocation duty desk for their efforts to allocate the organs of these donors. They would also like to thank the donor and recipient transplant centers and all e102 Transplantation ■ January 2022 ■ Volume 106 ■ Number 1 www.transplantjournal.com members of the transplant teams who supplied the followup information required for this study.

SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia

Organ transplantation from deceased donors with vaccine-induced thrombosis and thrombocytopenia

Thrombosis with thrombocytopenia syndrome associated with COVID-19 vaccines

Frequency of positive anti-PF4/ polyanion antibody tests after COVID-19 vaccination with ChAdOx1 nCoV-19 and BNT162b2