嘉義長庚紀念醫院 外科部 泌尿科
Pulmonary Embolism after Moderna Vaccination in Kidney Transplant: Two-Case Reports and Literature Review
Wai-Nga Chan*, Chih-Shou Chen, Dong-Ru Ho, Yun-Ching Huang, Jian-Hui Lin,
Kuo-Tsai Huang, Yu-Liang Liu
Divisions of Urology, Department of Surgery, Chang Gung Medical Foundation, Chiayi City, Taiwan
Introduction: Currently, pandemic COVID-19 is still an ongoing and constant emergence. However, due to upcoming new variants, vaccinations and boosters remain important in the future. The safety of vaccine in patient after kidney transplantation is an essential problem. Thrombosis is one of the severe side effects after vaccination. Vaccine-induced immune thrombotic thrombocytopenia (VITT) is the most accepted hypothetic mechanism for thromboembolic events with a presentation of thrombocytopenia, thrombosis and disseminated intravascular coagulation.
Here, we presented two cases with kidney transplantation who developed 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 cadaveric kidney transplantation since September 2008. Exertional dyspnea and right leg swelling happened at 23 days after the second Moderna vaccination, and pulmonary embolism with right femoral thrombosis were diagnosed. The second case was a 57-year-old man with history of type II diabetes and glaucoma who had living-related kidney transplantation since April 2013. He complained of exertional dyspnea at 26 days after the third Moderna vaccines who was diagnosed as pulmonary embolism.
The advantages of vaccination even in immunocompromised condition are outweigh of the side effects. CDC of USA recommended those who are moderately or severely immunocompromised patients should receive 3-dose series of an mRNA COVID-19 vaccine or a single dose of Janssen COVID-19 vaccine with a booster dose. However, we have to know the risk of deep vein thrombosis or even pulmonary emboli for these immunocompromised patients, which may not happen after the first vaccination. They are more easily confront with these unique complications since some immunosuppressants have already had the risk to happen deep vein thrombosis.