Kidney Transplantation From Deceased Donors With Vaccine-induced Immune Thrombocytopenia and Thrombosis: An Updated Analysis of the UK Experience.
Kidney Transplantation From Deceased Donors With Vaccine-induced Immune Thrombocytopenia and Thrombosis: An Updated Analysis of the UK Experience.
复制标题
患有疫苗诱导的免疫性血小板减少症和血栓形成的已故捐献者的肾移植：英国经验的最新分析。
DOI：
10.1097/tp.0000000000004190
复制
发表时间：
2022
期刊：
影响因子：
6.2
通讯作者：
Greenhall GHB
中科院分区：
文献类型：
--
作者：
Greenhall GHB
背景。接种严重急性呼吸综合征冠状病毒2疫苗后，疫苗引起的免疫性血小板减少症和血栓形成（VITT）的出现和随之而来的死亡率导致一些VITT患者被认为是死亡的器官捐赠者。在这种情况下，肾移植后的结果描述得很少。由于该疾病似乎是由抗血小板因子4抗体介导的，因此理论上存在通过同种异体移植物内的旅客白细胞传播的风险。方法：我们分析了2021年1月至6月期间英国VITT供体肾移植的经验。我们对所有VITT供者的纯肾移植受者进行随访，以发现主要的术后并发症或疾病传播特征，并评估移植物的存活和功能。结果：在我们的研究期间，有16例肾脏供者和30例单肾移植受者。在11个植入前活检中，4个显示广泛的肾小球微血栓。中位5个月后，患者和移植物的存活率分别为97%和90%。平均3个月肾小球滤过率为51 mL/min/1.73 m2。2例受者可检测到抗血小板因子4抗体，但移植后无临床疾病迹象。3例受者发生大出血并发症，均有出血的独立危险因素，导致2例移植物丢失。结论：到目前为止，英国的经验表明，有VITT的供者肾移植术后可能出现良好的结果，但强调需要对这些患者的供者相关并发症保持警惕。
Background.The emergence and attendant mortality of vaccine-induced immune thrombocytopenia and thrombosis (VITT) as a consequence of vaccination against severe acute respiratory syndrome coronavirus 2 have resulted in some patients with VITT being considered as deceased organ donors. Outcomes after kidney transplantation in this context are poorly described. Because the disease seems to be mediated by antiplatelet factor 4 antibodies, there is a theoretical risk of transmission via passenger leukocytes within the allograft.Methods.We analyzed the experience of kidney transplantation from donors with VITT in the United Kingdom between January and June 2021. We followed-up all recipients of kidney-only transplants from donors with VITT to detect major postoperative complications or features of disease transmission and assess graft survival and function.Results.There were 16 kidney donors and 30 single kidney transplant recipients in our study period. Of 11 preimplantation biopsies, 4 showed widespread glomerular microthrombi. After a median of 5 mo, patient and graft survival were 97% and 90%, respectively. The median 3-mo estimated glomerular filtration rate was 51 mL/min/1.73 m 2. Two recipients had detectable antiplatelet factor 4 antibodies but no evidence of clinical disease after transplantation. Major hemorrhagic complications occurred in 3 recipients, all of whom had independent risk factors for bleeding, resulting in the loss of 2 grafts. The involvement of VITT could not be completely excluded in one of these cases.Conclusions.The UK experience to date shows that favorable outcomes are possible after kidney transplantation from donors with VITT but highlights the need for ongoing vigilance for donor-related complications in these patients.