Correspondence on "Acute corneal endothelial graft rejection following COVID-19 vaccination".

Dear Editor, we would like to share ideas on “Acute corneal endothelial graft rejection following COVID-19 vaccination [1].” Crnej et al. concluded that SARS-CoV-2 vaccination might disrupt immune regulation enough to cause cornea transplant rejection [1]. We agree that there is an abnormal immunological process in the present. However, whether it is only a co-incidence or not requires further investigation. After a vaccination, a hyperstimulation of immune system might occur and it might result in a graft loss. The graft loss after vaccination is also reported in other vaccination such as yellow fever vaccination [2]. For COVID-19 vaccination, a response to vaccine can result in a rapid increasing of plasma viscosity [3]. Regarding this hypothesis, when COVID-19 vaccine is given, the immune response will occur and there is a rapid change of viscosity in circulation due to increased immune elements [3]. In some vaccine recipients, the hyperviscosity might occur and can lead to clinical problems [3]. Regarding graft rejection, high plasma viscosity is associated with cellular graft loss [4]. In animal transplantation model study, a high viscosity condition can block or a proper perfusion to graft area and decreased graft survival chance is a result [5].

Disclosure of interest

The authors declare that they have no competing interest.