Kidney Transplants From Donors With Vaccine-Induced ITP and Thrombosis

Researchers assessed the UK experience of kidney transplantations from deceased donors who had vaccine-induced immune thrombocytopenia and thrombosis (VITT), given the theoretical risk of transmission “via passenger leukocytes within the allograft.” Their report, published in Transplantation, found that favorable transplantation outcomes were possible with kidney donors with VITT.

However, the study’s lead author, George H. B. Greenhall, cautioned their data “highlights the need for ongoing vigilance for donor-related complications in these patients.”

The study reviewed 16 kidney donors and 30 single-kidney recipients in the UK who underwent transplants between January and June 2021. The study’s authors followed all kidney-only recipients from VITT donors to identify major postoperative complications or evidence of disease transmission, as well as graft survival and function.

Transplant Outcomes From Donors With Vaccine-Induced Immune Thrombocytopenia

According to the report, preimplantation biopsies of 11 kidneys identified 4 with widespread glomerular microthrombi. After a median follow-up of 5 months, patient and graft survival were 97% and 90%, respectively, the researchers noted. Additionally, the median 3-month estimated glomerular filtration rate was 51 mL/min/1.73 m2.

Notably, the research team identified 2 transplant recipients with detectable antiplatelet factor 4 antibodies—the potential mediating factor of VITT—but neither patient displayed signs of clinical disease during follow-up. Three recipients experienced major hemorrhagic complications resulting in the loss of 2 grafts, although the authors noted that all had independent risk factors for bleeding—however, “the involvement of VITT could not be completely excluded in one of these cases.”

In their conclusion, the study’s collaborators summarized, “Our findings advance existing knowledge and provide reasonable reassurance that good outcomes are likely after kidney transplantation from donors with VITT.”