Mandy Schlosser

Thrombotic thrombocytopenic purpura (TTP) may occur after vaccinations Here, we report a case of severe TTP early after vaccination against COVID-19.

Introduction: The German health care system lacks data on surgical complications and self-reported outcomes (SROs) of living donors. The prospective German Living Kidney Donor Registry, SOLKID-GNR aims to improve the assessment of donors' medical and psychosocial risks. Methods: Data were collected before (PRE) and 3 months after (POST) living kidney donation from transplantation centers (TCs) and donors via SROs. We reported perioperative complication rates for different surgical techniques and correlated them with donors' SROs. Datasets of 1020 donors from 30 German TCs were analyzed. Results: Donor nephrectomy procedures included laparoscopic (57.9%), retroperitoneoscopic (21.4%), open retroperitoneal (16.0%), or open abdominal nephrectomy (4.7%). Perioperative complications reported by TCs ranged from 9.8% (retroperitoneoscopic) to 17.1% (open abdominal), whereas those reported by donors ranged from 12.2% (open retroperitoneal) to 15.0% (open abdominal). Donors were discharged sooner and returned to work earlier after minimally invasive surgery; however, had comparable quality-of-life (QoL) after donation. The physical component summary (PCS) scores of the Short Form-12 (SF-12) were similar between the 4 surgical methods postdonation; however, they were lower in donors with TC- or self-reported complications than in those without. The mental component summary (MCS) scores of the SF-12 were lower in case of self-reported complications only. Despite 12.5% of self-reported complications, 96.4% expressed a willingness to donate again, and 94.1% felt well-informed. Conclusion: Although the surgical technique does not directly affect donors' QoL shortly after donation, minimally invasive procedures result in shorter hospital stays and a quicker return to work. Self-reported complications have a greater impact on mental QoL than those documented by transplant centers, highlighting the importance of subjective experiences during recovery.

Despite significant progress made in the treatment of patients with multiple myeloma (MM) in the last decade, for patients with early relapse or rapidly progressing high-risk disease, allogeneic hematopoietic stem cell transplantation (SCT) might be an option leading to long-term survival. Here, we retrospectively analyzed the outcomes of 90 MM patients who received allogeneic SCT in our center between 1999 and 2017. We specifically assessed the association of impaired humoral immune reconstitution, referred to as immunoparesis, and post-transplant survival. Sixty-four patients received allogeneic SCT in relapse following 2-7 lines of therapy; 26 patients received upfront tandem autologous-allogeneic SCT. With a median follow-up of 76 months, OS and PFS were 52.6% (95% CI 42.9-64.3) and 36.4% (95% CI 27.6-47.9) at 2 years and 38.6% (95% CI 29.2-51.1) and 25.3% (95% CI 17.5-36.4) at 5 years, respectively. Receiving more than two therapy lines prior to transplantation was an independent risk factor for OS (HR 3.68, 95% CI 2.02-6.70) and PFS (HR 3.69, 95% CI 2.09-6.50). In a landmark analysis at day 200, prolonged immunoparesis was associated with reduced OS (HR 3.22, 95% CI 1.14-9.11). Allogeneic stem cell transplantation offers an additional treatment element that may lead to long-term remission in selected patients with poor prognosis, probably exploiting graft-versus-myeloma effects. Immunoparesis could potentially serve as an indicator for impaired survival following allogeneic transplantation, an observation to be further studied prospectively.