• 1.

    Ison MG. Influenza prevention and treatment in transplant recipients and immunocompromised hosts. Influenza Other Respir Viruses 2013; 7 (Suppl 3):6066. doi: 10.1111/irv.12170

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Kumar D, et al. Guidance on novel influenza A/H1N1 in solid organ transplant recipients. Am J Transplant 2010; 10:1825. doi: 10.1111/j.1600-6143.2009.02960.x

  • 3.

    Michaels MG, et al. Coronavirus disease 2019: Implications of emerging infections for transplantation. Am J Transplant 2020; 20:17681772. doi: 10.1111/ajt.15832

  • 4.

    Shah MB, et al. Utilization of deceased donors during a pandemic: Argument against using SARS-CoV-2-positive donors. Am J Transplant 2020; 20:17951799. doi: 10.1111/ajt.15969

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Kute VB, et al. Is it safe to be transplanted from living donors who recovered from COVID-19? Experience of 31 kidney transplants in a multicenter cohort study from India. Transplantation 2021; 105:842850. doi: 10.1097/TP.0000000000003609

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Koval CE, et al. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: A report of 10 cases. Am J Transplant 2021; 21:37433749. doi: 10.1111/ajt.16765

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Jayasekera CR, et al. Solid organ transplantation from SARS-CoV-2-infected donors to uninfected recipients: A single-center experience. Transplant Direct 2022; 8:e1286. doi: 10.1097/TXD.0000000000001286

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Bock MJ, et al. Organ transplantation using COVID-19-positive deceased donors. Am J Transplant 2022; 22:22032216. doi: 10.1111/ajt.17145

Organ Transplantation Using SARS-CoV-2-Positive Deceased Donors

Manal Alotaibi Manal Alotaibi, MBBS, and Sam Kant, MD, are with the Division of Nephrology, Department of Medicine, and the Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD.

Search for other papers by Manal Alotaibi in
Current site
Google Scholar
PubMed
Close
and
Sam Kant Manal Alotaibi, MBBS, and Sam Kant, MD, are with the Division of Nephrology, Department of Medicine, and the Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD.

Search for other papers by Sam Kant in
Current site
Google Scholar
PubMed
Close
Full access

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected many aspects of organ transplantation. The decision to use a SARS-CoV-2-positive donor has remained controversial. Guidelines for organ donation in the setting of respiratory viral infections, such as influenza, exist with a recommendation to proceed with donation from influenza-infected donors only after they have been treated with antiviral therapy and have no further evidence of influenza in the lower airways. In addition, recipients of any organs from donors with influenza infection should receive a full therapeutic course of antiviral treatment (1, 2). Several reports have previously recommended against using SARS-CoV-2-infected organ donors over concerns of transmission by blood or allograft tissue, donor organ damage, a lack of effective therapies, health care worker exposures, and hospital resource utilization (3, 4). Nevertheless, a few cases, using low-risk donors known to be actively infected with or recovered from SARS-CoV-2 infection, have reported good early outcomes, albeit with extremely short follow-up periods (47).

Bock et al. (8), in the American Journal of Transplantation, conducted the largest retrospective cohort study to date using the Organ Procurement and Transplantation Network (OPTN) database (from March 15, 2020, to September 30, 2021) of patients undergoing solid organ transplantation from deceased donors with positive SARS-CoV-2 nucleic acid test (NAT) results. The dataset does not specify when this test result occurred, whether it was the first, most recent, or during donor evaluation.

Only donors with SARS-CoV-2 NAT results were included; of those, 150 donors (of 17,694 total donors) had positive SARS-CoV-2 NAT results. Of these, 124 donors had at least one organ transplanted with a total of 276 organs transplanted; 269 of them were matched to recipients in the appropriate datasets and comprised the study cohort. Transplants included 187 kidneys and five kidney-pancreas cases. There were four deceased pediatric donors, from which seven kidneys were transplanted, all into adult recipients. Three pediatric recipients received organs (two kidneys and one heart) from deceased adult SARS-CoV-2 NAT-positive donors. The cause of death in SARS-CoV-2 NAT-positive donors was due to anoxia in 33.8%, cerebrovascular disease or stroke in 20.8%, head trauma in 30.5%, other causes in 7.4%, and COVID-19 infection in 7.4%. There was no available information on those donors who did not proceed with organ recovery.

The primary endpoint was patient death across all organs, with secondary endpoints including patient death stratified by transplanted organ and graft failure across all organs. The data showed that graft survival for those receiving organs from SARS-CoV-2-positive deceased donors was equivalent to the survival of those receiving organs from SARS-CoV-2-negative donors, with no difference in actuarial survival between the two groups. The 30-day posttransplant patient-survival rates were similar. There were eight graft failures and five deaths, with two in the kidney transplant group. The first patient died due to respiratory failure at 109 days posttransplant, without providing a specific cause of respiratory failure in the article. The cause of death in the second patient was unknown. There were three graft losses in the kidney transplant group due to graft thromboses in two patients and recurrent disease in the third. The outcome was reached with a median 83-day follow-up time.

The results are encouraging, given the large sample size using the OPTN database—this is largest study in recipients receiving organs from SARS-CoV-2-positive deceased donors. Even though it has been recognized that transmissibility of the SARS-CoV-2 infection to recipients is low in the setting of organ donation, there is no reporting of transmission rates. In addition, the study lacks specific data regarding the severity of donor SARS-CoV-2 infections or organ involvement, the timing of SARS-CoV-2 infection, therapies such as remdesivir or monoclonal antibodies, and donor and recipient vaccination statuses. Information regarding the NAT cycle threshold is absent, and follow-up duration remains short. Additionally, there was a potential patient-selection bias by the transplant centers. Although death or graft loss was not directly due to SARS-CoV-2 infection, sepsis and respiratory failure in two patients could potentially be due to or influenced by SARS-CoV-2 infection. Additionally, two kidney graft losses and one liver death were attributed to graft or hepatic artery thrombosis, raising concerns of hypercoagulability related to COVID-19.

In summary, it can be tentatively concluded that SARS-CoV-2 status is not associated with worse graft outcomes or with patient survival in the early posttransplant period. Longer follow-up studies are necessary to determine long-term graft and patient outcomes, especially from an era in which vaccination rates are higher, and more potent therapies for COVID-19 are available. Importantly, studies need to elucidate risk and rates of transmission of the virus. Lastly, the instances of graft thrombosis are definitely concerning and do require further exploration if this event is a complication of donor SARS-CoV-2 infection and would involve stratification of recipients at high risk for this deleterious outcome.

References

  • 1.

    Ison MG. Influenza prevention and treatment in transplant recipients and immunocompromised hosts. Influenza Other Respir Viruses 2013; 7 (Suppl 3):6066. doi: 10.1111/irv.12170

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Kumar D, et al. Guidance on novel influenza A/H1N1 in solid organ transplant recipients. Am J Transplant 2010; 10:1825. doi: 10.1111/j.1600-6143.2009.02960.x

  • 3.

    Michaels MG, et al. Coronavirus disease 2019: Implications of emerging infections for transplantation. Am J Transplant 2020; 20:17681772. doi: 10.1111/ajt.15832

  • 4.

    Shah MB, et al. Utilization of deceased donors during a pandemic: Argument against using SARS-CoV-2-positive donors. Am J Transplant 2020; 20:17951799. doi: 10.1111/ajt.15969

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Kute VB, et al. Is it safe to be transplanted from living donors who recovered from COVID-19? Experience of 31 kidney transplants in a multicenter cohort study from India. Transplantation 2021; 105:842850. doi: 10.1097/TP.0000000000003609

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Koval CE, et al. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: A report of 10 cases. Am J Transplant 2021; 21:37433749. doi: 10.1111/ajt.16765

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Jayasekera CR, et al. Solid organ transplantation from SARS-CoV-2-infected donors to uninfected recipients: A single-center experience. Transplant Direct 2022; 8:e1286. doi: 10.1097/TXD.0000000000001286

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Bock MJ, et al. Organ transplantation using COVID-19-positive deceased donors. Am J Transplant 2022; 22:22032216. doi: 10.1111/ajt.17145

Save