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).
ABSTRACT
Background: Anticoagulant use during hemodialysis is a standard practice in both outpatients and inpatients setting. In an inpatient setting with heightened acuity of illness, the potential for bleeding attributable to anticoagulant is concerning. Hospitals have started applying an anticoagulant free HD protocol with success. COVID-19 patients showed a degree of systemic hypercoagulability with unique features, including a consumptive disseminated intravascular coagulation coexisting with hyperfibrinolysis and increased bleeding risk. Maintaining circuit patency and avoiding bleeding risk has been challenging. Data regarding anticoagulant in COVID-19 patients who received hemodialysis is limited. This study's primary objective is to compare hemodialysis clotting rate in COVID-19 patients who received anticoagulant versus those without anticoagulant. Methods: Retrospective chart review for all COVID-19 patients who received hemodialysis at Banner Medical Center Tucson Campus Between November 2020 and January 2021. Primary outcome was clotting rate during hemodialysis. CRRT was excluded. Results: 330 total patients observed, 56% sessions in the ICU unit and 44% in the medicine unit. 57% were AKI and 43% were ESRD. Anticoagulant use was 38.5% (heparin IVP during hemodialysis was 12%, continuous systemic heparin was 16% and others (warfarin, DOAC, Argatroban, etc) was 11%). Clotting rate was 12%. Other characteristics can be seen on the table 1. There was no difference in the clotting rate between group with anticoagulant versus without anticoagulant (8% vs.15%, p value 0.06). Multivariable logistic regression for clotting outcome showed that compared to no-anticoagulation, systemic heparin continuous infusion decreased clotting by 83% (OR 0.17, 95% CI 0.04-0.77, p-value=0.02) and others anticoagulant decreased clotting by 91% (OR=0.09, 95% CI 0.01-0.85);compared to AV fistula, temporary dialysis catheter increased clotting by 2.9x (OR 2.9, 95% CI 1.10-7.44, p-value=0.03);and every 10 increase in platelet count increased clotting by 4% (OR 1.04, 95% CI 1.01-1.07, p value =0.01) Conclusions: No anticoagulation and temporary catheters carry high risk for clotting in patients with COVID undergoing iHD. Continuous heparin should be considered.