Comparative Outcomes at a Single Center for 71 Deceased Donor Kidney Transplants from Donors with Sars-CoV-2 RNA Detection

ABSTRACT

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).