Kidney transplantation from SARS-CoV-2–positive deceased donor

Abstract

To expand the available donor pool, many organ procurement organizations and transplant programs have begun to consider severe acute respiratory syndrome coronavirus (SARS-CoV-2) nucleic acid test positive candidates. 1 It is becoming increasingly clear that not all donors with a positive nucleic acid amplification test for SARS-CoV-2 are contagious, and some of these organs can be transplanted with careful selection. 2,3 Data from 31 kidney transplants from living donors with resolved COVID-19 in India showed the safety of this approach. 4 However, it is unknown whether kidneys from donors with active COVID-19 can also be safely transplanted. 3,5 Beyond the "active" infection designation, it is clinically possible to risk stratify donors with COVID-19 based on additional parameters such as clinical history and radiologic or laboratory findings. Here we present a case and 210-day outcome of a successful kidney transplantation from otherwise medically suitable SARS-CoV-2 PCR-positive deceased donors.

Utilization and outcomes of deceased donor SARS-CoV-2–positive organs for solid organ transplantation in the United States

“…These data complement prior smaller single‐center reports and case series and may provide assurance that, at least short‐term outcomes are not compromised by use of these organs. 7 , 8 , 9 , 10 , 11 , 13 , 20 , 21 In the context of kidney transplantation, the current study indicated no difference in rates of delayed graft function or 6‐month graft survival and the characteristics of recipients was similar between negative and positive SARS‐CoV‐2 status donors. Similarly for liver and transplant recipients, both general characteristics of recipients and 6‐month graft survival were similar by SARS‐CoV‐2 status donors.…”

“… 7 , 8 , 9 Due to ongoing uncertainties regarding the relative risks of transplantation with donors with prior or active infections, evidence for the safe use of organs from SARS‐CoV‐2–positive donors has emerged slowly with small case series from individual centers. 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Although early results appear promising, best practices for utilization of positive SARS‐CoV‐2 donors remain unclear. 7 , 8 , 9 , 11 , 17 , 18 , 19 …”

“… 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Although early results appear promising, best practices for utilization of positive SARS‐CoV‐2 donors remain unclear. 7 , 8 , 9 , 11 , 17 , 18 , 19 …”

Organ transplantation using COVID-19-positive deceased donors

“…Despite these early recommendations, reports of organ transplantation using donors known to be actively infected with or recovered from COVID‐19 infection began to emerge. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Initial reports came from donors who had previously been infected with COVID‐19 but had subsequently recovered. Later cases included those with lower‐risk donors and recipients who either had a personal history of COVID‐19 infection in the past and/or had antibodies to COVID‐19 present.…”

Medical decisions in organ donors and heart transplant candidates with history of COVID‐19 infection: An international practice survey

“…Since the relatively less virulent Omicron COVID‐19 variant became predominant, some programs moved to using organs from selected COVID‐19 positive donors, and treating recipients prophylactically for COVID‐19 after transplant. This practice has so far been mostly limited to nonthoracic organ transplant 10,11 …”