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Successful Kidney Transplantation from Covid-19 Positive Donors
Kidney International Reports ; 8(3 Supplement):S455, 2023.
Article in English | EMBASE | ID: covidwho-2259937
ABSTRACT

Introduction:

Covid-19 results in a wide spectrum of illness ranging from asymptomatic, mild to severe respiratory disease and multi-organ involvement. Transplant recipients are at increased risk of severe Covid-19. The risk of transmission from a Covid-19 positive donor to recipient in kidney transplantation is unknown. National Health Service Blood and Transplant, UK recommended respiratory polymerase chain reaction (PCR) testing for all donors for Covid-19 and advice against organ donation if positive within the last 28 days. However, a recent amendment of guideline (www.odt.nhs.uk, POL304/3) supports organ donation from selected donors with positive or indeterminate SARS-CoV-2 PCR results. Method(s) We report two cases of kidney transplantation including one unvaccinated recipient where donors had tested SARS-CoV-2 PCR positive. Result(s) 1 Mrs A is a 38-year old Caucasian with end-stage kidney disease (ESKD) secondary to reflux nephropathy, established on haemodialysis (HD). She had declined Covid-19 vaccinations. The donor died of traumatic brain injury and he had a positive lateral flow test 3 weeks prior. The PCR test was positive. Decision was made to proceed with deceased donor kidney transplantation. She was high immunological risk with a HLA antibody calculated reaction frequency (CRF) of 79%, donor specific antibody negative. She was given Basiliximab induction followed by Tacrolimus, Mycophenolate Mofetil and steroids. Graft function was immediate and at 3 week post-transplant, she is well with excellent graft function and no evidence of Covid-19. 2 Mrs B is a 63-year old Asian with ESKD secondary to diabetes and hypertension. She was established on HD and fully vaccinated (three doses of Pfizer-BNT162b2 mRNA vaccine). The donor died of subarchnoid haemorrhage. He had a positive lateral flow test 15 days prior with flu-like symptoms. Respiratory PCR for SARS-CoV-2 was positive. The decision was to proceed with deceased donor transplantation. She was low immunological risk with a HLA antibody CRF of 0%. There were no peri-operative complications and she had immediate graft function. She had Basiliximab induction and was discharged on Tacrolimus and Mycophenolate mofetil with prednisolone withdrawn on day 7 (our low immunological risk protocol). At 3 week post-transplant, she is well with no evidence of Covid-19 and excellent graft function. Conclusion(s) We report 2 cases of kidney transplantation from Covid-19 positive donors in whom the cause of death was not Covid-19 pneumonia. Covid-19 status of the donor was discussed with the patients who both consented. Neither recipient developed Covid-19 in the early post-transplant period, despite being heavily immunosuppressed. Although there remains a theoretical risk, there are no reports of transmission of Covid-19 to kidney transplant recipients from positive donors. Prophylactic antivirals or monoclonal antibodies for the recipient post-transplant or spike antibody test to guide decision making are not currently recommended. We used clinical details of the donor and virology advice which accounts for PCR cycle threshold value to make a decision to transplant. The outcomes of 2 patients reported along with similar experience from other centres is encouraging and supports use of kidneys from selected SARS-CoV-2 positive deceased donors after obtaining virological advice and appropriate consent. No conflict of interestCopyright © 2023
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Kidney International Reports Year: 2023 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Kidney International Reports Year: 2023 Document Type: Article