ABSTRACT
Background: We recently reported that in United States, 388 organs from SARSCoV- 2 nucleic acid test (NAT) positive 150 donors were procured between Aug 2020 to Sep 2021. Nearly 1 million deaths have been attributed to SARS-CoV-2 pandemic however only selected group of donor organs were assessed for transplantation. Even after procurement, 28% (of 388) organs were discarded. For kidney transplants (KT), commonest reason for relatively high-quality organ discards (35%) was 'exhaustion of wait list', indicating reluctance to accept these organs. Method(s): We investigated potential risk of donor transmission of SARS-CoV-2 by a prospective study including 23 KT recipients with prior SARS-CoV-2 vaccination. Donor serum and pre-implantation kidney biopsy tissue were assessed for detection of SARSCoV- 2 via a validated commercially available real-time reverse transcription polymerase chain reaction (RT-PCR) (threshold 73 copies/mL). All recipients had SARS-CoV-2 RTPCR on plasma and nasopharyngeal swab at Day-7 post-KT. Result(s): A total of 23 KT were performed from 22 SARS-CoV-2 NAT positive donors between Nov 2021 and Feb 2022. All 22-donor serum samples and 23 procurement biopsies were negative for SARS-CoV-2, including those from 8 donors with symptomatic disease. Six (of 22 donors;27%) had death attributable to SARS-CoV-2 complications. Three recipients with asymptomatic donors were diagnosed with clinical SARS-CoV-2 disease at 10, 14, and 23 days post-KT during 4th pandemic surge. Both graft and patient survival rate was 100% at a median 3 month followup. Collation with national 'Organ Procurement and Transplant Network' registry showed that majority of other organs from these donors were not procured [zero pancreata, zero lungs, 11 (50%) livers, 19 (86%) hearts]. Among 42 KT [55% (23/42) performed at our center], 10 transplanted livers, and 3 hearts;no graft loss or death was reported. Conclusion(s): In this single-center study we report an absence of detectable SARSCoV- 2 virus in donor kidney tissue and plasma from SARS-CoV-2 positive donors.and absence of recipient viremia and nasopharyngeal detectable virus immediately after KT indicating a lack of donor transmission. Our results of excellent graft and patient survival favor utilization of SARS-CoV-2 infected donors.
ABSTRACT
Purpose: Expansion of the donor pool remains a major unmet need for solid organ transplants (SOT). Early data suggests that at least some severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID) nucleic acid test positive (NAT+) organs could be transplanted safely although there is substantial controversy about this topic. Method(s): A retrospective analysis of the national United States Organ Procurement and Transplantation Network database was performed, demonstrating initial experience with COVID NAT+ deceased donor organs with a focus on kidney transplants, from August 8, 2020, to Sep 29, 2021. Result(s): During this time period, 17,143 COVID NAT negative (NAT-) deceased donors and 150 COVID NAT+ deceased donors were assessed for organ donation (Figure 1) (Table 1). When compared to COVID NAT- donors, there was a higher (p<0.001 for all) non-recovery rate for COVID NAT+ hearts (35% vs 87%), lungs (71% vs 99%), livers (24% vs 53%), and pancreas (89% vs 98 %). Of a total of 385 recovered organs from 150 COVID NAT+ donors, 276 (72%) organs were transplanted into 262 recipients. Majority of donors had a COVID NAT+ <=7 days prior to procurement (94;62.7%). While only a minority of pancreases, hearts, lungs, and livers were procured, almost all were transplanted post-procurement. In contrast, there was a high discard rate for kidneys post-procurement (102/295;34.6%) with the most common reason (~70%) for discards being 'exhaustion of the wait list'. Presumably superior quality COVID NAT+ kidneys were discarded compared with COVID NAT- kidneys (mean KDPI: 67% vs 76%;p=0.04). Limited outcome data was available with a median post-transplant follow-up of 75 days (range: 23-243 days). Three kidney allograft losses (2 due to allograft thrombosis) and five deaths (2 kidneys, 3 livers) were reported, of which, one was due to respiratory failure and one due to sepsis. Conclusion(s): These data provide early reassuring evidence on the utilization of non-lung COVID NAT+ organs. However, a substantially lower procurement rate for non-kidney transplantable organs and a high discard rate for kidneys were noted. (Table Presented).