Kidney Transplantation from a Deceased Donor with COVID-19 Ad26.COV2-S Vaccine-Induced Thrombotic Thrombocytopenia.

BACKGROUND Vaccine-induced thrombosis and thrombocytopenia is a rare immune disorder documented after adenoviral vector ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2-S (Janssen) vaccine administration against severe acute respiratory syndrome coronavirus 2. It is a rare adverse effect with an incidence of 1 case per 100 000 exposures. The disorder represents altered immune response with proliferation of antibodies that bind to platelet factor 4 (PF4), leading to formation of thrombi and consumptive coagulopathy. Thrombosis combined with thrombocytopenia generally occurs in the first month following vaccination and can lead to fatal outcome, even in young, previously healthy individuals. These young adults ultimately may become solid organ donors. The main concerns with vaccine-induced thrombosis and thrombocytopenia solid organ donors are anti-PF4 antibodies transmission potential, risk of early major graft thrombosis, and serious bleeding. CASE REPORT In our center, 2 kidney transplantations were performed from a single brain-dead vaccine-induced thrombosis and thrombocytopenia donor following Ad26.COV2-S COVID-19 (Janssen) vaccine in October 2021, which represents the first 2 cases of kidney transplantation from a deceased vaccine-induced thrombosis and thrombocytopenia donor after immunization with Ad26.COV2-S (Janssen) vaccine. Both recipients were closely monitored in the early post-transplantation period and after discharge from the hospital. To date, both recipients have a good functioning allograft, without any evidence of vaccine-induced thrombosis and thrombocytopenia transmission. CONCLUSIONS Our results are consistent with those of previously published cases of successful vaccine-induced thrombosis and thrombocytopenia donor solid organ transplantation. Kidney allografts transplanted from vaccine-induced thrombosis and thrombocytopenia donors can have a good overall function with favorable outcomes.

Antibiotic prophylaxis prior to transrectal prostate biopsy in Croatia: A national survey.

OBJECTIVES: Transrectal ultrasound guided prostate biopsy (TRUSPB) is the standard of care for diagnosis of prostate cancer. Increased antibiotic resistance has led to the suspension of indication for fluoroquinolones use in prostate biopsy prophylaxis. Several classes of antibiotics have been recommended for routine use. Unequivocal consensus regarding antibiotic prophylaxis has not been made to date. The objective of the study was to assess the diversity of antimicrobial prophylaxis among Croatian urologists. MATERIALS AND METHODS: An online questionnaire was designed using Google Forms® and distributed to 19 urology public hospital's departments. Answers regarding infection risk assessment, type and duration of antimicrobial prophylaxis were accumulated. Descriptive statistical analysis was preformed using Statistica 10.0® analytics software. RESULTS: Twelve urology departments answered the questionnaire, representing 63% of urology departments in Croatia. Six different antibiotic protocols have been reported. Fluoroquinolones were the most commonly prescribed class of antibiotics (84%). Antibiotic prophylaxis started 1 day before the procedure (92%). Average duration of antibiotic prophylaxis was 5 days (75%). In case of increased risk of urinary tract infection, 42% of departments changed the type, and 8% changed the duration of antibiotic prophylaxis. Neither department performed a rectal swab prior to prostate biopsy. CONCLUSIONS: Various antimicrobial prophylaxis protocols are currently being used among Croatian urology departments. Lack of uniform guidelines contributes to protocol diverseness that inevitably leads to further increase in antibiotic resistance. New high quality studies are needed to reverse this trend and to facilitate the establishment of a uniform antimicrobial stewardship strategy.