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

Nguyen, Michelle C.; Lee, Eliza J.; Avery, Robin K.; Dioverti, M. Veronica; Shoham, Shmuel; Tobian, Aaron A.R.; Bloch, Evan M.; Gürakar, Ahmet; Rizkalla, Nicole; Cameron, Andrew M.; King, Elizabeth A.; Ottmann, Shane; Garonzik-Wang, Jacqueline M; Wesson, Russel N; Philosophe, Benjamin

doi:10.1097/txd.0000000000001178

Cited by 18 publications

(26 citation statements)

References 21 publications

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“…To date, there are only 13 single case reports and 1 multicenter case series (N = 10) cumulatively of 24 nonlung organ transplants (16 kidneys, 15 livers, and 3 hearts) from SARS-CoV-2-infected donors. [8][9][10][11][12][13][14][15][16][17][18] Fifteen of those 24 recipients had no previous SARS-CoV-2 infection or vaccination (8/16 kidney recipients, 5/15 liver recipients, 2/3 heart recipients), and there was no virus transmission. There are also reports of at least 45 kidneys, 14 livers, and 6 hearts transplanted from 55 donors with fully resolved SARS-CoV-2 infection with no evidence of virus transmission.…”

Section: Discussionmentioning

confidence: 99%

Solid Organ Transplantation From SARS-CoV-2–infected Donors to Uninfected Recipients: A Single-center Experience

Jayasekera

Vikram

Rifat

et al. 2022

Transplantation Direct

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Background. The risk of donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in solid organ (heart, lung, liver, kidney, pancreas, and intestine) transplant recipients is poorly understood. Since hematogenous transmission of SARS-CoV-2 has not been documented to date, nonlung solid organs might be suitable for transplantation since they likely portend a low risk of viral transmission. Methods. Abdominal solid organs from SARS-CoV-2–infected donors were transplanted into uninfected recipients. Results. Between April 18, 2021, and October 30, 2021, we performed transplants of 2 livers, 1 simultaneous liver and kidney, 1 kidney, and 1 simultaneous kidney and pancreas from SARS-CoV-2–infected donors into 5 uninfected recipients. None of the recipients developed SARS-CoV-2 infection or coronavirus disease 2019, and when tested, allograft biopsies showed no evidence of SARS-CoV-2 RNA. Conclusions. Transplanting nonlung organs from SARS-CoV-2–infected donors into uninfected recipients demonstrated no evidence of virus transmission.

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Section: Discussionmentioning

confidence: 99%

Solid Organ Transplantation From SARS-CoV-2–infected Donors to Uninfected Recipients: A Single-center Experience

Jayasekera

Vikram

Rifat

et al. 2022

Transplantation Direct

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“…In that patient, multiple postoperative nasopharyngeal swabs were negative for Sars-CoV-2, indicating that the organ damage was independent of active infection but not ruling out the possibility of COVID-19 sequelae. Of six recipients of livers from actively infected donors, three reported graft complications: one hepatic artery thrombosis [ 40 ], ascribed to technical factors; one mild presumed acute cellular rejection; [ 41 ] and one biopsy-proven COVID-19 hepatitis [ 31 ].…”

Section: Graft Outcomesmentioning

confidence: 99%

Use of Organs from SARS-CoV-2 Infected Donors: Is It Safe? A Contemporary Review

et al. 2021

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Purpose of Review As the prevalence of individuals with recovered coronavirus disease 2019 (COVID-19) increases, determining if and when organs from these donors can be safely used is an important priority. We examined current knowledge of outcomes of transplant using donors with recovered COVID-19. Recent Findings A literature search of PubMed and Google scholar databases was conducted to identify articles with terms “SARS-CoV2,” “COVID-19,” “donor recovered,” and “transplantation” published through 08/10/2021. We identified 25 reports detailing 94 recipients of both abdominal and thoracic transplants from donors with both prior and active COVID-19 infection. Rates of transmission to the recipient and of transplanted organ dysfunction were low among reports of donors with prior COVID-19 infection. End organ dysfunction and transmission were more common with active infection, although few reports are available. Standardized reporting is needed to better assess the impact of donor symptomatology, cycle thresholds, and individual recipient risk factors on postoperative outcomes. Summary Available reports suggest that transplantation from COVID-19 donors may be feasible and safe, at least in short term follow-up. Nevertheless, there is a need for standardized testing and management protocols which should be tailored for available resources. While increased availability of COVID-19 vaccinations will mitigate risks of donor-derived COVID-19 and simplify management, continued vigilance is warranted during the ongoing public health emergency.

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“…However, the use of extra‐pulmonary organs from the same donors has resulted in no clinical signs of donor‐derived SARS‐CoV‐2 and no reported ill‐ effects on allograft or patient outcomes 9,11 . Case reports, small case series and now recent summative OPTN data of liver, kidney and heart transplantation from donors with SARS‐CoV‐2 detection have been published with excellent recipient outcomes 12–25 . While the OPTN data is supportive of the safe use of organs from donors with SARS‐CoV‐2 detection, donor and recipient details that may illustrate the likelihood of active infection or infection‐related complications are lacking 25 …”

Section: Introductionmentioning

confidence: 99%

Comparative outcomes for over 100 deceased donor kidney transplants from SARS-CoV-2 positive donors: A single-center experience

Koval

Eltemamy

Poggio

et al. 2022

American Journal of Transplantation

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Emerging data supports the safety of transplantation of extra‐pulmonary organs from donors with SARS‐CoV‐2‐detection. Our center offered kidney transplantation (KT) from deceased donors (DD) with SARS‐CoV‐2 with and without COVID‐19 as cause of death (CoV+COD and CoV+) to consenting candidates. No pre‐emptive antiviral therapies were given. We retrospectively compared outcomes to contemporaneous DDKTs with negative SARS‐CoV‐2 testing (CoVneg). From 2/01/2021 to 01/31/2022, there were 220 adult KTs, including 115 (52%) from 35 CoV+ and 33 CoV+COD donors. Compared to CoVneg and CoV+, CoV+COD were more often DCD (100% vs 40% and 46%, p<0.01) with longer cold ischemia times (25.2h vs 22.9h and 22.2h, p=0.02). At median follow‐up of 5.7 months, recipients of CoV+, CoV+COD and CoVneg kidneys had similar rates of delayed graft function (10.3%, 21.8% and 21.9%, p=0.16), rejection (5.1%, 0% and 8.5%, p=0.07), graft failure (1.7%, 0% and 0%, p=0.35), mortality (0.9%, 0% and 3.7%; p=0.29), and COVID‐19 diagnoses (13.6%, 7.1%, and 15.2%, p=0.33). Though follow‐up was shorter, CoV+COD was associated with lower but acceptable eGFR on multivariable analysis. KT from DDs at various stages of SARS‐CoV‐2 infection appears safe and successful. Extended follow‐up is required to assess the impact of CoV+COD donors on longer term graft function.

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

Abstract: Supplemental Digital Content is available in the text.

Cited by 18 publications

References 21 publications

Solid Organ Transplantation From SARS-CoV-2–infected Donors to Uninfected Recipients: A Single-center Experience

Solid Organ Transplantation From SARS-CoV-2–infected Donors to Uninfected Recipients: A Single-center Experience

Use of Organs from SARS-CoV-2 Infected Donors: Is It Safe? A Contemporary Review

Comparative outcomes for over 100 deceased donor kidney transplants from SARS-CoV-2 positive donors: A single-center experience

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