Transplantation Journal - May 2021 Issue

This month the issue has a number of fascinating insights into different facets of transplantation. Will the lung go the way of the heart into wearable artificial lungs providing a bridge to transplantation? An expert consensus statement from ILTS on procurement surgery in DCD liver donation will surely influence practice. Viruses claim attention again - and while there is some information on COVID, the focus is on JC Virus Nephropathy and a great review of influenza in transplant recipients. The first reported transplantation of a nulliparous uterus that resulted in a successful pregnancy is a small but important step in replacement strategies for human reproduction. The impact of islet transplantation on cardiac autonomic neuropathy and two nice articles on haemopoietic stem cell transplantation ensure that there is something for everyone in the field.

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A Real-World Look at COVID-19 Vaccines Versus New Variants

May 4 - Clinical trials have shown the COVID-19 vaccines now being administered around the country are highly effective in protecting fully vaccinated individuals from the coronavirus SARS-CoV-2. But will they continue to offer sufficient protection as the frequency of more transmissible and, in some cases, deadly emerging variants rise?

Heart Retrieval Technique May Boost Organs for Transplant by 20%

May 6 - In a small observational study that tested normothermic regional perfusion (NRP) for donation after cardiac death (DCD), posttransplant cardiac function was "excellent" in 8 of 8 transplant recipients, and survival after a mean of 237 days was 100%.

Dynamic View of Spike Protein Reveals Prime Targets for COVID-19 Treatments

This striking portrait features the spike protein that crowns SARS-CoV-2, the coronavirus that causes COVID-19. This highly flexible protein has settled here into one of its many possible conformations during the process of docking onto a human cell before infecting it.

Hot off the Press 

«HOT OFF THE PRESS» 
RECENT PUBLICATIONS IDENTIFIED
BY TTS EDUCATION COMMITTEE ON COVID-19

Selected Publications by TTS Education Committee. This week's selection made by Drs. Enver Akalin, Millie Samaniego, and Marlies Reinders.

Immunogenicity of the BNT162b2 mRNA Vaccine in Heart Transplanted Patients-A Prospective Cohort Study.

Itzhaki Ben Zadok et al.
Eur J Heart Fail., 2021 Apr 29. doi: 10.1002/ejhf.2198
A prospective single-center cohort study of HTx recipients who received a 2-dose SARSCoV-2 mRNA vaccine (BNT162b2, Pfizer-BioNTech). Whole blood for anti-spike IgG (S-IgG) antibodies were drawn at days 21-26 and at days 35-40 after the first vaccine dose. 42 HTx recipients at a median age of 61 (IQR 44, 69) years. Median time from HTx to the 1st vaccine dose was 9.1 (IQR 2.6, 14) years. Only 15% of HTx recipients demonstrated the presence of positive S-IgG antibody titers in response to the 1st vaccine dose (GMT 90 (IQR 54, 229) AU/mL). Forty-nine percent of HTx recipients induced S-IgG antibodies in response to either the 1st or the full 2-dose vaccine schedule (GMT 426 (IQR 106, 884) AU/mL). Older age (68 (IQR 59, 70) years vs. 46 (IQR 34, 63) years, p = 0.034) and anti-metabolites-based immunosuppression protocols (89% vs. 44%, p = 0.011) were associated with low immunogenicity. Importantly, 36% of HTx recipients who were non-responders to 1st vaccine dose became S-IgG seropositive in response to the 2nd vaccine dose.

US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021

Isaac See et al.
JAMA. Published April 30, 2021 doi:10.1001/jama.2021.7517
Case series of 12 US patients with Cerebral venous sinus thrombosis (CVST) and thrombocytopenia following use of Ad26.COV2.S vaccine reported to the Vaccine Adverse Event Reporting System (VAERS). Seven patients had at least 1 CVST risk factor, including obesity (n = 6), hypothyroidism (n = 1), and oral contraceptive use (n = 1); none had documented prior heparin exposure. Time from Ad26.COV2.S vaccination to symptom onset ranged from 6 to 15 days. Eleven patients initially presented with headache; 1 patient initially presented with back pain and later developed headache. Of the 12 patients with CVST, 7 also had intracerebral hemorrhage; 8 had non-CVST thromboses. After diagnosis of CVST, 6 patients initially received heparin treatment. Platelet nadir ranged from 9 ×103/μL to 127 ×103/μL. All 11 patients tested for the heparin-platelet factor 4 HIT antibody by enzyme-linked immunosorbent assay (ELISA) screening had positive results. All patients were hospitalized (10 in an intensive care unit [ICU]). As of April 21, 2021, outcomes were death (n = 3), continued ICU care (n = 3), continued non-ICU hospitalization (n = 2), and discharged home (n = 4).

Impaired Humoral Response in Renal Transplant Recipients to SARS-CoV-2 Vaccination with BNT162b2 (Pfizer-BioNTech)

Johannes Korth et al.
Viruses, 2021 Apr 25;13(5):756. doi: 10.3390/v13050756.
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has a major impact on transplant recipients, with mortality rates up to 20%. Therefore, the effect of established messenger RNA (mRNA)-based SARS-CoV-2 vaccines have to be evaluated for solid organ transplant patients (SOT) since they are known to have poor responses after vaccination. We investigated the SARS-CoV-2 immune response via SARS-CoV-2 IgG detection in 23 renal transplant recipients after two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 following the standard protocol. The antibody response was evaluated once with an anti-SARS-CoV-2 IgG CLIA 15.8 +/- 3.0 days after the second dose. As a control, SARS-CoV-2 IgG was determined in 23 healthcare workers (HCW) and compared to the patient cohort. Only 5 of 23 (22%) renal transplant recipients were tested positive for SARS-CoV-2 IgG antibodies after the second dose of vaccine. In contrast, all 23 (100%) HCWs were tested positive for antibodies after the second dose. Thus, the humoral response of renal transplant recipients after two doses of the mRNA-based vaccine BNT162b2 (Pfizer-BioNTech, Kronach, Germany) is impaired and significantly lower compared to healthy controls (22% vs. 100%; p = 0.0001). Individual vaccination strategies might be beneficial in these vulnerable patients.

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