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1.
American Journal of Transplantation ; 22(Supplement 3):404, 2022.
Article in English | EMBASE | ID: covidwho-2063367

ABSTRACT

Purpose: The OPTN DTAC, a multidisciplinary group, evaluates potential donor derived transmission events (PDDTE) to assess the likelihood of disease transmission. Method(s): Retrospective study of PDDTE cases reported to the OPTN between 01/20 and 12/20. DTAC reviewed cases using a standardized classification algorithm. Result(s): During 2020, there were 18,318 donors and 37,583 unique recipients. DTAC reviewed 261/427 PDDTE from donor (111) or recipient (150) findings. 64/261 (25%) donors had proven/probable transmission (P/P Tr) of infection, malignancies or other to 84/206 (41%) exposed recipients [figure]. 12 involved living donors. Infection occurred with 44/64 P/P cases affecting 63 recipients. Viruses were most frequent P/P infections with 29 recipients having P/P Tr from 19 donors. COVID-19 PDDTE represented 11% (29/261) of all cases reviewed involving 29 donors and 15 lung and 76 non-lung recipients. One lung recipient had P/P Tr and died;none of the non-lung recipients developed P/P Tr. For bacteria, 20 recipients had P/P Tr from 14 donors. Deaths from infection (N=10) occurred at a median of 20 days (5-89 days). Attributable death was highest for fungal (4/12, 33%) and bacterial infections (6/20, 30%). 7 donors with malignancies were classified as P/P impacting 15 recipients with 1 attributable death. 53 non-infection, non-malignancy PDDTE were reported;13 resulted in P/P Tr to 14 recipients. Conclusion(s): Although P/P events remain rare, 1/4 reviewed cases resulted in unanticipated P/P Tr. This is a conservative estimate due to passive reporting and empiric interventions. In 29 COVID-19 PDDTE only 1 lung recipient had P/P Tr. The DTAC continues to evaluate PDDTE to maximize organ use and minimize the risk of transmission. (Table Presented).

2.
American Journal of Transplantation ; 22(Supplement 3):452, 2022.
Article in English | EMBASE | ID: covidwho-2063348

ABSTRACT

Purpose: The OPTN implemented emergency policy on 5/27/21 requiring lower respiratory testing (LRT) by nucleic acid test (NAT) for SARS-CoV-2 (COVID-19) for all potential deceased lung donors. Our objective was to assess the policy's impact on organ utilization and patient safety. Method(s): OPTN data were analyzed for LRT information reported in discrete data fields or attachments in DonorNet for deceased lung donors recovered 5/27/21- 10/31/21. We used natural language processing to identify donor attachments with terminology related to COVID-19 (e.g., "COVID", "SARS-COV-2") and LRT (e.g., "BAL", "tracheal aspirate") in the attachment filename or description. Result(s): In the first 5 months since implementation, lungs were transplanted from 1037 donors (963 (92.9%) non-DCD, 74 (7.1%) DCD) (Figure). Lung utilization decreased slightly from pre- to post-policy for both non-DCD and DCD donors (overall: 17.7% vs 16.2%;non-DCD: 22.9% vs 21.7%;DCD: 5.1% vs 3.8%). 99.8% (N=1035/1037) of transplanted lung donors had LRT;the majority (99.2%) had LRT results reported in DonorNet on/before day of lung transplant. There have been no reported potential donor-derived SARS-CoV-2 transmissions to lung recipients since implementation. 58 donors had a positive LRT (LRT+), including 27 (46.6%) with a negative upper respiratory test. Lungs were not transplanted from 57/58 LRT+ donors;1 LRT+ donor was believed to be a false positive based on confirmatory test results and had lungs transplanted. Non-lung organs were recovered and transplanted from LRT+ donors without evidence of disease transmission (Table). While the kidney discard rate was higher for LRT+ donors relative to donors without LRT+ (30.2% vs 24.8%), liver discards were lower (5.6% vs 9.9%), and heart utilization was similar (27.6% vs 28.0%). Conclusion(s): Early results suggest that the LRT policy has minimized the risk of donor-derived COVID-19 transmission to lung recipients with minimal impact on lung utilization and allowing transplantation of non-lung organs from LRT+ donors. (Figure Presented).

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