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Background/aims: Controlled DCD organ donation (cDCD) is a strategic target for the Italian transplantation network. Italian peculiarities in cDCD donation make published results questionable and raise concern over organ ischemic damage. Consequently, normothermic regional perfusion (NRP) has been strongly recommended in potential cDCD donors. In 2019 the randomized multicenter DONARE study was designed to describe ischemic-reperfusion and inflammatory biomarkers during NRP and to test the potential benefit of apheresis by an adsorbent filter (CytoSorb) included in the NRP circuit. The aim of this report is to describe the modulation of the clinical characteristics and of the NRP in the DONARE study enrolled cases. Method(s): The study protocol was defined by the DCD national working group and proposed to all the Italian DCD donation centers. The coordinating center (CNT) has monitored the evolving cDCD activity to preserve the study capacity of representing the Italian scenario. Samples have been blindly centralized to an independent laboratory for cytokines profiling. The outcomes of transplanted organs have been recorded in the national quality database. Result(s): From September 2020 to June 2022, 27 out of the 40 planned cases have been enrolled in six centers: 4 in 2020, 12 in 2021 and 11 within June 2022. Approval is still pending in other centers. Main causes of exclusion among potential cDCD donors were: age above 65 (in 2020), e-CPR prior- to-death, shortage in personnel and COVID-19 restrictions. The age limit for enrolment (<65yrs) was abolished by amendment due to the national trend: mean age of enrolled cases increased from 57+/-6 in 2020 to 67+/-6 years in 2022. Mean NRP duration decreased from 223,3+/-39,2 in 2020 to 168,9+/-42,6 minutes in 2022;serial samples (4/2 with/without Cytosorb, from T0 to T4) from different points of the NRP circuit have been completed throughout the procedure in all the cases. All the enrolled cases became utilized donors. No study-related adverse event has been reported. Conclusion(s): Coordination of multicenter studies in the rapidly evolving scenario of controlled DCD donation should take advantage of continuous monitoring of real-life procedures and auditing of adherence to operational recommendations. The interim evaluation confirms the feasibility and safety of the study.
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The COVID-19 pandemic strongly affected organ procurement and transplantation in France, despite the intense efforts of all participants in this domain. In 2020, the identification and procurement of deceased donors fell by 12% and 21% respectively, compared with the mean of the preceding 2 years. Similarly, the number of new registrations on the national waiting list declined by 12% and the number of transplants by 24%. The 3-month cumulative incidence of death or drop out for worsening condition of patients awaiting a liver transplant was significantly greater in 2020 compared to the previous 2 years. Continuous monitoring at the national level of early post-transplant outcomes showed no deterioration for any organ in 2020. At the end of 2020, less than 1% of transplant candidates and less than 1% of graft recipients - of any organ - had died of COVID-19.Copyright © 2021 The Author(s)
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Purpose: Currently there are no UNOS guidelines regarding the selection criteria required for simultaneous heart-kidney transplant recipients (SHKT). As of 2018 our center has begun performing these dual transplants for appropriate candidates. We report on the criteria devised to guide SHKT candidate selection at our institution and the subsequent clinical outcomes. Method(s): This is a single center, retrospective study of 26 patients who received SHKT at our institution from Dec 2018 to Oct 2021. A multidisciplinary team composed of heart and kidney transplant medical and surgical members determined appropriate recipient-donor SHKT candidate pairs. Selection criteria for SHKT was established by our kidney transplant group and included an evaluation for chronic kidney disease (CKD) or evidence of acute kidney injury (AKI) with a prolonged course or requiring renal replacement therapy (RRT). The surgery was conducted according to our institution's standardized protocols. The majority of patients received IL2-RA and methylprednisolone induction therapy, and all patients received triple immunosuppression therapy with prednisone, mycophenolate mofetil and tacrolimus. Adjustments in long term therapy were made in collaboration between the heart and kidney transplant teams. Result(s): From Dec 2018 to Oct 2021, 26 patients underwent SHKT at our institution. 24 patients (92%) carried a diagnosis of chronic kidney disease (CKD) as defined as an eGFR <60 ml/min/1.73m2 for at least 90 days on at least two separate tests. Clinical risk factors for CKD, the presence of proteinuria, and renal imaging data were also taken into consideration when determining a diagnosis of CKD. Two patients (8%) carried a diagnosis of stage III AKI for at least 4 weeks and required renal replacement therapy during their hospital course. Of our 26 patients, one patient received a DCD donor and 12 patients (46%) received hepatitis C donors. 25 patients (96%) received induction therapy with IL2-RA. During the first 3 months post-transplant, the only patient who received ATG had 7 severe infections;11 patients (44%) and 13 patients (52%) who received IL2 -RA had no infections and <= 4 mild infections, respectively. One patient died due to COVID 19 pneumonia complicated by multisystem organ failure. For a median follow up period of 410 (187-707) days, 8% patients in the IL2-RA induction cohort experienced a 2R/3A heart rejection, 8% patients remained on HD due to primary kidney graft nonfunction, and the survival rate was 96%. Conclusion(s): UNOS guidelines regarding selection criteria for SHKT are an important next step in the care of heart transplant candidates with kidney disease, particularly as the number of SHKT performed yearly increase. Compared to the literature, our data supports the use of standardized criteria for SHKT selection and the use of IL2- RA as an induction strategy with excellent patient survival.
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Purpose: Transplantation of kidneys from donors with active SARS-CoV-2 infection is uncommon due to concerns about the risk of viral transmission and kidney quality. To date, there is no conclusive data that viral transmission from extra-pulmonary solid organ transplant is a possibility. Given the prevalence of SARS-CoV-2 infections in potential donors, the shortage of kidneys available for transplantation and the low risk of viral transmission, we developed a clinical protocol for accepting kidneys from donors with active SARS-CoV-2 infection and preserved kidney function. Method(s): Retrospective chart review of 5 kidney transplant recipients from 4 deceased donors with severe SARS-CoV-2 infection. Donor and recipient characteristics are reported using descriptive characteristics. Result(s): Donor creatinine ranged from 0.51 to 0.60 mg/dL and KDPI ranged from 14% to 52%. Three of the 5 kidneys came from donation after circulatory death donors. All recipients were fully vaccinated, and 4/5 received post-exposure prophylactic monoclonal antibody treatment. 3 recipients had delayed graft function but were off of dialysis by postoperative day 6 or 8. 3 recipients were readmitted, one for fluid overload and mild rejection on two different occasions, one for hypotension from dehydration and one for sepsis secondary to an aspiration pneumonia. The latter recipient subsequently died with a functioning graft secondary to a severe bacterial infection. This recipient was also found to have a femoral DVT during readmission on the contralateral side to the kidney graft. At 30 days post-transplant, no recipients displayed signs or symptoms of SARS-CoV-2 infection and the three who were readmitted tested negative for SARS-CoV-2 via nasopharyngeal swab. All had a creatinine less than 2 at the most recent follow up. Conclusion(s): Our findings suggest that kidney grafts from donors with severe SARSCoV- 2 infection but preserved kidney function can be safely used and have good early outcomes. However, more research is needed to determine the safety and long term outcomes of kidney transplantation from donors with severe COVID-19 pneumonia.
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Purpose: Effective March 15, 2021, the OPTN launched a new policy for matching kidney and pancreas transplant candidates with organs from deceased donors. The new policy was projected to increase equity in transplant access for candidates nationwide by using a scoring system based on a reference of 250 nautical mile radius from donor hospital. Various factors can influence the transplant rates including wait list size, organ acceptance practices as well as access to transplant centers in rural and socio-economically disadvantaged parts of the country. Small volume centers have short waitlist and candidates lower on the national list. With the current change in allocation, they may be forced to accept high risk kidneys. The new allocation may impact outcomes for such centers to stay active and maintain volumes. We propose to evaluate the impact of the allocation change on the kidney transplant practices at our center situated in rural setting. Method(s): A cohort study was designed comparing transplant characteristics of all patients undergoing kidney transplant at our center. The study population was all patients who had a kidney transplant after March 15, 2021. The cohort group was all patients who underwent a kidney transplant at our center from Jan 1, 2019 to Dec 31, 2019. The year 2020 was not considered because of COVID-19 pandemic. Data collected included donor demographics, recipient demographics, donor quality indices and recipient allograft function, transplant related complications. Result(s): There were 66 patients in the pre and the 49 in post allocation group. The most common cause of renal failure was diabetes in both. There were no statistically significant differences in recipient demographics. There was a dramatic increase in the number of DCD donors (48% pre vs 80% post, p 0.007). The cold ischemia time was significantly increased (20hr 5m pre vs 23hr 45m post, p 0.002). The serum creatinine trend showed higher serum creatinine at 1, 3 and 6 months post transplant in the post allocation group. Delayed graft function was seen in 3% in pre vs 10% in post group. There was an increase in hospital stay (6 days vs 8 days). Conclusion(s): The new allocation system may increase utilization DCD kidneys. It also prolongs cold ischemia time. This can result in prolonged hospital stay and DGF rates and result in higher serum creatinine levels. The impact of this on low volume centers and rural hospital systems may decrease organ transplant rates in such areas and lead to disparity in transplant access.
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Purpose: The global COVID-19 pandemic has significantly altered delivery of healthcare. Hospital resource utilization has been impacted on multiple levels including solid organ transplantation and overall access to transplant care. In the United States, significant regional variation and decreased living donor transplantation occurred during the initial 6 months of the pandemic. We examined the multi-year impact of COVID-19 on pediatric organ donation and transplantation. Method(s): Pediatric (<18 years of age) organ donation and transplant data was obtained from the Organ Procurement and Transplantation Network (OPTN). Data included pediatric donors after brain death (pDBD), donors after circulatory death (pDCD), living donors (LD), and recipient details including total number of transplants, waitlist deaths, and removals were reviewed between January 2019 to December 2021. Result(s): Total pediatric transplants performed in 2019, 2020, and 2021 were 1923, 1766, and 1890 (p=0.004) respectively. Organ specific data is outlined in Table 1. In 2019, 2020, and 2021, living donor transplantation accounted for 320, 288, and 311 (p=0.838) cases, while 1579, 1456, and 1552 (p=<0.0001) deceased donor allografts were utilized. There were 171, 176, and 209 pDCD and 746, 684, and 713 pediatric pDBD donors. Living donors across all recipient ages were 7391, 5725, and 6539. 2392, 2337, and 2430 pediatric patients were added to all organ waitlists during the study period. 2347, 2198, and 2288 children were removed from the waitlist with 93, 82, and 76 of those cases due to patient death. There was no statistically significant difference in the proportion of pediatric patients added to the waitlist vs those removed during 2019-2021 (p=0.505) Conclusion(s): Transplant volume transiently decreased in the first six months of the COVID-19 pandemic. However, transplantation rates in children, specifically abdominal organ transplantation, increased to nearly pre-pandemic levels in 2021. Lung transplants were significantly decreased during the study period. Pediatric donation remained relatively steady from 2019-2021. Living donor transplantation in children was significantly impacted in 2020. Waitlist additions/removals remained consistent throughout the study period. (Table Presented).
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Purpose: Until recently, donor COVID positivity was seen as a contraindication for donation or transplantation. Our OPO has recently adopted a practice in which organs from COVID positive donors could be offered for transplantation if they presented greater than 10 days after onset of symptoms. Method(s): We reviewed our database for COVID positive organ donors from 2/1/21 to 11/1/21. A total of 11 donors were examined, of which 5 met criteria DCD and 6 were brain dead (DBD). UNET was reviewed to determine donor demographics, clinical presentation, and WIT Results: Of the 5 COVID positive DCD donors, only 3 kidneys were placed from 2 donors (Table 1) for an OTPD = 0.60. Four of the 5 donors died of complications of COVID. Of the 3 DCD donors where no organ was placed, the local list was exhausted and aggressive centers were contacted at the time of organ offer. No DCD COVID positive livers were placed. Sequence placement ranged from #671 to #7829. COVID negative DCD donors resulted in OTPD = 1.81. Of the 6 COVID positive DBD donors (Table 2), a total of 10 kidneys, 1 pancreas, 3 hearts, and 4 livers were placed for an OTPD of 3.00. None of the 6 donors died of complications of COVID. Five of the 6 donors presented with negative nasopharyngeal swabs but were later positive on repeat NP swab, tracheal aspirate, or BAL. The 6th donor had a history of symptomatic COVID one month prior to brain death and was persistently PCR positive on NP swab. All COVID positive kidneys, the pancreas, 1 of the 3 hearts, and 2 of the 4 livers were placed within our UNOS region. Sequence placement ranged from #1 to #2676. COVID negative DBD donors during the same time resulted in OTPD = 3.24. Conclusion(s): Our early analysis demonstrated several low-KDPI DCD organs with short WIT that went unused, while DBD organs with COVID positivity were used at nearly the rate of non-COVID DBD donors. We did not place any COVID positive DCD extra-renal organs. Our COVID DBD donors were placed at nearly the same rate as non-COVID, albeit at higher sequence. We believe that DCD donors that are COVID positive reflect an underutilized source of transplantable organs. Further investigation should be undertaken on a broader scale to encourage utilization of these organs and to study their short-and long-term outcomes.
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Purpose: The coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of healthcare, including organ donation and transplantation. The purpose of this study is to demonstrate that utilization of COVID-positive organs can be carried out safely. Method(s): De-identified data from 569 organ donors processed through an organ procurement organization (OPO) from March 24, 2020, through September 30, 2021, was collected from the OPO's database and retrospectively analyzed. Demographics, clinical measures, transplant numbers, and outcomes were recorded. Result(s): 25 COVID-positive (study) and 544 COVID-negative (control) organ donors were analyzed. There was no significant difference between the mean ages of the study group (43.12+/-11.08, p = 0.665) and the control group (44.15+/-17.94, p = 0.665). The COVID-positive group achieved donor management goals at a significantly lower rate than the COVID-negative group (4.0% vs 48.7%, p = 0.000012). The COVID-positive group required significantly more continuous renal replacement therapy (16.0% vs 1.8%, p < 0.00001), and extracorporeal membrane oxygenation (24.0% vs 0.7%, p < 0.00001). Significantly fewer organs were transplanted from the COVID-positive donors (1.12+/-1.013, p < 0.00001) than from the COVIDnegative donors (2.56+/-1.671, p < 0.00001). The mean observed to expected ratio for the study group (0.5372+/-0.47434, p < 0.00001) was significantly lower than that of the control group (0.9489+/-0.55041, p < 0.00001). The study group donors were significantly more likely to be categorized as donation after circulatory death (DCD) donors (96.0% vs 27.8%, p < 0.00001). There was no significant difference between the groups regarding delayed graft function in the recipient (18.2% vs 26.8%, p = 0.522561) nor regarding the need for dialysis post-transplant (9.1% vs 11.6%, p = 0.795292). Conclusion(s): Fewer organs from COVID-positive donors were utilized for transplantation than organs from COVID-negative donors over the study period. COVID-positive organs have been of no detriment to recipients, as there is no evidence of increased delayed graft function nor the need for dialysis. Though no short-term COVID-19 transmission has been identified, we will continue to monitor for this and to track non-renal transplant outcomes. A larger multi-center study is warranted to further delineate the safety and efficacy of implementing protocols to utilize these organs.
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Purpose: At the beginning of the pandemic, kidneys from SARS-CoV-2 (COVID) RT-PCR positive donors were not utilized for transplantation, due to the risk of viral transmission. With the advent of the COVID vaccines, and improved monoclonal antibody therapy we transplanted organs from COVID positive donors irrespective of disease severity. Method(s): We performed six kidney transplants from COVID RT-PCR positive donors. Potential donors were screened for the date of the first positive COVID RTPCR. Only donors whose test had been positive at least 10 days prior to donation on a nasopharyngeal swab or bronchoalveolar lavage were accepted. A cycle threshold (ct)of >= 35 cycles was used as a cut off for accepting kidneys, when results were available prior to donation. Disease severity was not considered in donor evaluation. Recipient selection was performed based on willingness to give informed consent for the use of such kidneys, prior vaccination with at least 2 doses of the COVID vaccine and negative RT-PCRs in the month prior to transplantation. Result(s): We successfully transplanted 6 recipients from 5 donors. While one of the kidneys was recovered locally, the remainder were imported as non mandatory nationally shared organs. Four donors suffered from ARDS secondary to COVID pneumonia. Two donors were on ECMO at the time of donation. Two of the 5 donors were DCD recoveries with warm ischemic times times of 22 and 28 minutes. Co-infections in the donors included Candida glabrata, Enterococcus faecalis, and Burkholderia Cepacia for which appropriate prophylaxis was used in the recipients. All donors had positive nasopharyngeal RT-PCRs. Three had positive bronchioloalveolar lavage RT-PCRs. One donor was RT-PCR negative at the time of donation. Three recipients were sensitized with a PRA of 48%, 96%and 100%. The mean cold ischemic time was 25 hours. The mean KDPI was 51%. The delayed graft function rate was 33%. There was no primary nonfunction, rejection, death or graft loss after median follow-up of 87 (30-250days). The mean recipient GFR was 43ml/min. Dual kidney transplants were performed in two recipients. None of the recipients developed a COVID infection. 5/6 recipients received monoclonal antibodies (casirivimab and imdevimab) immediately after reperfusion. One patient did not receive casirivimab and imdevimab as it was not yet available in our region. All 6 patients received Thymoglobulin induction. Conclusion(s): With careful selection of immunized recipients, clinical assessment of transmission risk, and the preemptive use of monoclonal antibodies post exposure , SARS-Cov-2 positive donor kidneys can be safely utilized for single or dual kidney transplantation, without an increased risk of viral transmission, rejection or graft loss.
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Purpose: Extra-pulmonary organs from donors with SARS-CoV-2 detection during donor evaluation are not accepted by many centers due to theoretical concerns for productive infection and organ injury from COVID-related sequelae. We aimed to compare outcomes for kidney transplantation (KT) from donors with and without SAR-CoV-2 RNA detection, CoVD+ and CoVDneg, respectively. Method(s): We retrospectively reviewed donor data, recipient data and key outcomes for all adult CoVD+ KTs performed at our center between 2/1/2021 and 10/31/2021 and compared such data to all consecutive adult CoVDneg KTs during the same period. Organ selection was by protocol and excluded donors within the 1st 14 days of diagnosed symptomatic infection. No COVID-directed therapies were provided to CoVD+ KT recipients (KTRs). Vaccination was not required in early 2021. Result(s): There were 159 KTs, including 71 (44%) from 41 CoVD+'s with mean follow up 151d (range 35-291d). Of the 41 CoV+ donors, 16 (40%) died of COVID complications, mostly hypoxic respiratory failure, with 4 on VV ECMO. For those dying of COVID, the median time from first SARS-CoV2 RNA detection to donation was 28d (range 16-65). Compared to CoVneg donors, CoV+D's had lower KDPI (mean 31 v 43, mean difference -10.8, 95% CI -18.41 to -3.17, p=0.006), and were more likely DCD (OR 2.41, 95% CI 1.28-0.463, p=0.007). Having a CoV+ donor was not associated with delayed graft function (DGF). On multivariable analysis, CoVD+ was not associated with a higher serum creatinine (Cr) at 1, 3 or 6 months, but DCD was. There was 1 death (from pre-existing interstitial lung disease without SARS-CoV-2 detection from the lower airway) at 4 mo and 1 graft loss at 6 wk post-KT, both in the CoVD+ group. Neither of these KTR's donors had died of a COVID-related cause. Rejection occurred in 3 CoVD+ and 4 CoVneg KTRs. Six (3.7%) KTRs were diagnosed with COVID, all >3 mo post-KT, with 5/6 occurring >6 mo post-KT during peak periods of circulating virus. Conclusion(s): In a large series, kidney transplant outcomes from CoVD+s were similar to CoVDnegs up to 6 months post-transplant. CoVD+ KT recipients likely benefited from lower KDPI organs. We demonstrate safe and successful transplantation of CoVD+ kidneys outside of the peak period of symptomatic SARS-CoV-2 infection. (Figure Presented).
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Purpose: Decision to transplant organs from SARS-CoV-2 NAT+ donors(N+D) balances risk of donor-derived infection with the scarcity of available organs to meet the needs of waitlisted candidates. Method(s): OPTN Ad Hoc Disease Transmission Advisory Committee (DTAC) reports on the use of organs from N+D from the onset of required SARS-CoV-2 lower respiratory tract(LRT) testing for lung donors (May 27, 2021) through August 31, 2021. OPTN data were analyzed for donors with a positive LRT or upper respiratory tract (URT) test reported in DonorNet discrete data fields (N+D), compared with donors who did not have positive LRT or URT in the discrete data fields (N-D). Result(s): Organs were recovered from 120 N+D (all OPTN Regions and 40/57 OPOs (70%)). Median donor age was 42 (IQR: 32-52) for N+D and 43 (30-56) for N-D. There was a greater proportion of DCD N+D than N-D (37.5% vs 28.3%, p=0.04). Underlying COD of anoxia and other were different (N+D 31.7%, 16.7% vs N-D 48%, 2.7%, respectively). Transplanted N+D and N-D did not differ by KDPI, LDRI or LVEF for kidney(KT), liver(LT) or heart(HT), respectively (Table 1). Median time from donor admission to first reported test (any result) was 0 and 4 days for URT and LRT, respectively. N+D recovery occurred a median of 2 (IQR: 1-6) days from last positive test. 246 organs (152KT, 50LT, 22HT, 22other) were transplanted from 107 N+D compared to 8969 organs from 3348 N-D. Recipients from N+D and N-D were similar in age, MELD/PELD (LT) and medical urgency status (HT). Median time from listing to transplant similar for N+D for all organs. The match run sequence number for final acceptor was higher for N+D for all organ types (Table 2). Median length of stay was similar for N+D and N-D for KT and LT (5d and 12-13d, respectively). For HT, median stay was shorter for N+D (30 vs 34d). For N+D, 3 of 50 LT died within 30d of transplant. During this timeframe, no PDDTEs were reported for any N+D at the time of transplant. Conclusion(s): N+D and N-D were similar in terms organ quality characteristics. Recipients receiving organs from N+D had higher match run sequence numbers, suggesting use of organs from N+D is not widespread across centers;however, with small numbers, this data will need to be verified. We cannot assess the relatedness of the three early mortality events in N+D recipients to donor or recipient characteristics. However, these data highlight the importance of ongoing outcome review of N+D recipients. (Figure Presented).
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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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BACKGROUND AND AIMS: The poor humoral response after vaccination against SARS-CoV-2 in kidney transplant (KT) patients led to the approval of a third dose. Recent data show an increase in the antibody titer, although lower than in the general population. Our aim is to analyze the humoral immune response after the third dose a mRNA vaccine against SARS-CoV-2 and the evolution of the antispike antibody (antiS) titers in KT recipients. METHOD: We performed a prospective cohort study of stable KT patients from our center who received three doses of a mRNA vaccine from March to November 2021. KT recipients with less than 6 months after transplantation and with active oncological or hematologic disease were excluded. We determined antiS titers (Abbott SARS-CoV- 2 IgG chemiluminescent microparticle immunoassay) at baseline, one month after the second dose and one month after the third one. We compared those KT patients who seroconverted with 2 and with 3 doses of vaccine and those who did not seroconvert. To identify risk factors for no seroconversion, a logistic regression analysis was carried out. RESULTS: We included 83 KT. Mean age was 59.3 years and 62.7% were male. The median time from KT to the first vaccine dose was 94 months and between the second and third dose median time was 4 months. Seroconversion rate was 63.8% after 2 doses and 85.5% after the third one (P < 0.001). Twelve KT did not develop antibodies (Table 1). Patients who did not seroconvert were older (P = 0.047), had a worse renal function (P = 0.009) and had fewer lymphocytes than those that developed antibodies (0.013). Besides, they almost half of them received a KT from a non-heart-beating donor (P = 0.026) and were treated with thymoglobulin in the 2 years prior to the vaccine more frequently (P = 0.007). In patients who seroconverted after 2 doses, we observed a 10-fold increase in the antiS titer after the third vaccine (82 [34-350] UI/mL versus 814 [205-2415] UI/mL;P < 0.001). No patients had neither acute rejection nor serious adverse effects. In the multivariable analysis advanced age, a worse kidney function and recent treatment with thymoglobulin were risk factors for no seroconversion (Table 1). CONCLUSION: The third dose of a mRNA vaccine against SARS-CoV-2 significantly increased the seroconversion rate and the antiS titers in stable KT patients. Advanced age, poorer kidney function and immunosuppressive treatment are risk factors for no seroconversion. (Table Presented).
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INTRODUCTION: COVID-19 forced conversations between ICU patients' families and organ procurement organizations (OPOs) by phone, as opposed to in-person. We hypothesized that a phone approach of a patient's family would be a negative predictor of donation authorization success. METHODS: We conducted a retrospective observational study of a database of ICU patients from 2017-2020 whose families had been approached by New England Donor Services for organ donation. We excluded approaches of registered potential donors after brain death because authorization was already secured. In addition to whether OPO approach occurred in person or by phone, we extracted data on patient and surrogate demographics, OPO representative training, and ICU-to-OPO transitions. The outcome of interest was successful donation authorization. Univariate and multivariate analyses were conducted to determine predictors of successful authorization. RESULTS: Among 2240 approaches of potential organ donors, OPO approaches by phone constituted 221/1282 (17%) of successful authorizations, as opposed to 134/958 (14%) of failed attempts (p=0.04). No significant betweengroup differences were observed amongst racial subgroups. Amongst all successful authorization approaches, mean patient age was lower (43.3 vs. 45.1, p=0.008);and higher percentages of white/non-Hispanic patients (75.8 vs. 63.3, p< 0.001), previously registered potential DCD donors (78.2 vs. 21.8, p< 0.001), parents as the key family surrogate (43.6 vs. 33.8, p< 0.001), OPO representatives being specially trained in authorization approach (91.2 vs. 79.5, p< 0.001), and ICU-OPO collaborative donation processes (85.4 vs. 72.7, p< 0.001) were seen. Fewer unplanned mentions of donation by ICU staff were seen among successful authorizations (12.3 vs. 22.3, p< 0.001). In a multivariate model, phone approach, patient age, and unplanned hospital mentions no longer had significant associations with successful authorization, but the other variables above were all strong predictors. CONCLUSIONS: OPO approach by phone is not a barrier to successful organ donation. Strategies for successful approaches should focus instead on cultivating a collaborative process between ICU teams and OPOs and prioritizing the involvement of OPO representatives with special training for discussing authorization.
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The proceedings contain 205 papers. The topics discussed include: waitlist outcomes for liver waitlist candidates 1-year following the implementation of MMAT/250 score;bariatric surgery associated ventricular modeling decreases need for heart transplantation;antibody response to a third dose of SARS-CoV-2 vaccine in solid organ transplant recipients: mRNA and viral vector boosters;socioeconomic deprivation of 'closed for no contact' kidney transplant referrals;designing continuous distribution for liver allocation;the impact of functional donor warm ischemia time on incidence of ischemic cholangiopathy following DCD liver transplantation;and xenogeneic cross-circulation for extracorporeal recovery of human lungs declined after ex vivo lung perfusion.