Complement-Mediated Thrombotic Microangiopathy Related to COVID-19 or SARS-CoV-2 Vaccination

Christof Aigner; Martina Gaggl; Sophie Schmidt; Renate Kain; Nicolas Kozakowski; André Oszwald; Zoltán Prohászka; Raute Sunder-Plassmann; Alice Schmidt; Gere Sunder-Plassmann

doi:10.1016/j.ekir.2023.05.010

Complement-Mediated Thrombotic Microangiopathy Related to COVID-19 or SARS-CoV-2 Vaccination

Kidney Int Rep. 2023 May 22;8(8):1506-1513. doi: 10.1016/j.ekir.2023.05.010. Online ahead of print.

Affiliations

¹ Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
² Department of Pathology, Medical University of Vienna, Vienna, Austria.
³ Research Laboratory, Department of Internal Medicine and Hematology, and Research Group for Immunology and Hematology, Semmelweis University- EötvösLoránd Research Network (Office for Supported Research Groups), Budapest, Hungary.
⁴ Genetics Laboratory, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.

Abstract

Introduction: Infectious diseases and vaccinations are trigger factors for thrombotic microangiopathy. Consequently, the COVID-19 pandemic could have an effect on disease manifestation or relapse in patients with atypical hemolytic syndrome/complement-mediated thrombotic microangiopathy (aHUS/cTMA).

Methods: We employed the Vienna TMA cohort database to examine the incidence of COVID-19 related and of SARS-CoV-2 vaccination-related relapse of aHUS/cTMA among patients previously diagnosed with aHUS/cTMA during the first 2.5 years of the COVID-19 pandemic. We calculated incidence rates, including respective confidence intervals (CIs) and used Cox proportional hazard models for comparison of aHUS/cTMA episodes following infection or vaccination.

Results: Among 27 patients with aHUS/cTMA, 13 infections triggered 3 (23%) TMA episodes, whereas 70 vaccinations triggered 1 TMA episode (1%; odds ratio 0.04; 95% CI 0.003-0.37, P = 0.01). In total, the incidence of TMA after COVID-19 or SARS-CoV-2 vaccination was 6 cases per 100 patient years (95% CI 0.017-0.164) (4.5/100 patient years for COVID-19 and 1.5/100 patient years for SARS-CoV-2 vaccination). The mean follow-up time was 2.31 ± 0.26 years (total amount: 22,118 days; 62.5 years) to either the end of the follow-up or TMA relapse (outcome). Between 2012 and 2022 we did not find a significant increase in the incidence of aHUS/cTMA.

Conclusion: COVID-19 is associated with a higher risk for aHUS/cTMA recurrence when compared to SARS-CoV-2 vaccination. Overall, the incidence of aHUS/cTMA after COVID-19 infection or SARS-CoV-2 vaccination is low and comparable to that described in the literature.

Keywords: COVID-19; SARS-CoV-2; genetic renal disease; hemolytic uremic syndrome; thrombotic microangiopathy; vaccination.