Donor to recipient transmission of SARS-CoV-2 by lung transplantation despite negative donor upper respiratory tract testing

Abstract

We describe a case of proven transmission of SARS‐CoV‐2 from lung donor to recipient. The donor had no clinical history or findings suggestive of infection with SARS‐CoV‐2 and tested negative by reverse transcriptase polymerase chain reaction (RT‐PCR) on a nasopharyngeal (NP) swab obtained within 48 h of procurement. Lower respiratory tract testing was not performed. The recipient developed fever, hypotension, and pulmonary infiltrates on posttransplant day (PTD) 3, and RT‐PCR testing for SARS‐CoV‐2 on an NP swab specimen was non‐reactive, but positive on bronchoalveolar lavage (BAL) fluid. One thoracic surgeon present during the transplantation procedure developed COVID‐19. Sequence analysis of isolates from donor BAL fluid (obtained at procurement), the recipient, and the infected thoracic surgeon proved donor origin of recipient and health‐care worker (HCW) infection. No other organs were procured from this donor. Transplant centers and organ procurement organizations should perform SARS‐CoV‐2 testing of lower respiratory tract specimens from potential lung donors, and consider enhanced personal protective equipment for HCWs involved in lung procurement and transplantation.

Transplant of SARS-CoV-2–infected Living Donor Liver: Case Report

“…A case of donor-derived SARS-CoV-2 transmission has been described in a lung transplant recipient whose lung donor tested negative for SARS-CoV-2 by nasopharyngeal PCR but was retrospectively found to be positive on bronchoalveolar lavage fluid obtained at procurement. 17 Currently, there are no clinical data that accurately define the risk of transmission of SARS-CoV-2 with liver transplant. Several small studies do provide insight to SARS-CoV-2 viremia and organotropism beyond the respiratory tract.…”

Viral infections in lung transplantation

“…International scientific societies advice against the use of organs from deceased donors tested positive for SARS-CoV-2, particularly for lung donors (81-83). However, a case report describing a proven transmission of SARS-CoV-2 from a lung donor, who tested negative by RT-PCR on a nasopharyngeal swab but positive on bronchoalveolar lavage fluid when subsequently tested, supports universal SARS-CoV-2 testing in the lower respiratory tract before lung donation (84).…”

Rapid Diagnosis of SARS-CoV-2 Pneumonia on Lower Respiratory Tract Specimens

“…Recently, a case of SARS-CoV-2 transmission during the lung transplantation has been reported despite a negative result from the pre-implantation NP swab of the donor. The assessment of LRT specimens from potential lung donors should be therefore preferred for the virological screening prior to the transplant [11]. Similar investigations will be recommended also for other organ transplants because the wide tropism of SARS-CoV-2 that is detected in multiple sample types (plasma, rectal swabs, stool, urine, kidney and lung tissues) [12].…”