Chan Wai-Nga, Chen Chih-Shou, Ho Dong-Ru, Huang Yun-Ching, Lin Jian-Hui, Huang Kuo-Tsai, Liu Yu-Liang
Divisions of Urology, Department of Surgery, Chang Gung Medical Foundation, Chiayi City 613, Taiwan.
Vaccines (Basel). 2022 May 29;10(6):868. doi: 10.3390/vaccines10060868.
Currently, the coronavirus disease 2019 (COVID-19) pandemic is still an ongoing and constant medical issue, and with upcoming new variants, vaccinations and boosters remain important. The safety of vaccines in patients after kidney transplantation is an essential problem, with thrombosis being one of the severe side effects and vaccine-induced immune thrombotic thrombocytopenia (VITT) revealed as the most commonly reported syndrome for thromboembolic events following COVID-19 vaccination. Here, we present two cases of kidney transplantation developing pulmonary embolism post-Moderna vaccination within 30 days without thrombocytopenia. The first case was a 52-year-old man with history of type II diabetes, hypertension and hyperlipidemia who had had cadaveric kidney transplantation in September 2008, where right leg swelling with claudication occurred 23 days after the second Moderna vaccination. The second case was a 57-year-old man with history of type II diabetes and glaucoma who had had living-related kidney transplantation in April 2013 and then complained of exertional dyspnea 26 days after administration of the third Moderna vaccine. The advantages of vaccination even in immunocompromised patients far outweigh the disadvantages, although clinicians must understand the risks of deep-vein thrombosis or even pulmonary embolism for such patients, which might not occur after just the first vaccination.
目前，2019冠状病毒病（COVID-19）大流行仍是一个持续存在的医学问题，随着新变种的出现，疫苗接种和加强针仍然很重要。肾移植患者接种疫苗的安全性是一个关键问题，血栓形成是严重的副作用之一，而疫苗诱导的免疫性血栓性血小板减少症（VITT）是COVID-19疫苗接种后血栓栓塞事件最常报告的综合征。在此，我们报告两例肾移植患者在接种Moderna疫苗后30天内发生肺栓塞且无血小板减少症的病例。第一例是一名52岁男性，有II型糖尿病、高血压和高脂血症病史，于2008年9月接受尸体肾移植，在第二次接种Moderna疫苗23天后出现右腿肿胀伴间歇性跛行。第二例是一名57岁男性，有II型糖尿病和青光眼病史，于2013年4月接受亲属活体肾移植，在接种第三剂Moderna疫苗26天后出现劳力性呼吸困难。即使对于免疫功能低下的患者，接种疫苗的好处也远远大于坏处，尽管临床医生必须了解此类患者发生深静脉血栓甚至肺栓塞的风险，而且这种情况可能不会仅在首次接种后就出现。
