Purpose of Review As the prevalence of individuals with recovered coronavirus disease 2019 (COVID-19) increases, determining if and when organs from these donors can be safely used is an important priority. We examined current knowledge of outcomes of transplant using donors with recovered COVID-19. Recent Findings A literature search of PubMed and Google scholar databases was conducted to identify articles with terms “SARS-CoV2,” “COVID-19,” “donor recovered,” and “transplantation” published through 08/10/2021. We identified 25 reports detailing 94 recipients of both abdominal and thoracic transplants from donors with both prior and active COVID-19 infection. Rates of transmission to the recipient and of transplanted organ dysfunction were low among reports of donors with prior COVID-19 infection. End organ dysfunction and transmission were more common with active infection, although few reports are available. Standardized reporting is needed to better assess the impact of donor symptomatology, cycle thresholds, and individual recipient risk factors on postoperative outcomes. Summary Available reports suggest that transplantation from COVID-19 donors may be feasible and safe, at least in short term follow-up. Nevertheless, there is a need for standardized testing and management protocols which should be tailored for available resources. While increased availability of COVID-19 vaccinations will mitigate risks of donor-derived COVID-19 and simplify management, continued vigilance is warranted during the ongoing public health emergency.

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Introduction Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infection has drastically impacted the transplant communities. Remdesivir (RDV) has shown some promising results in coronavirus disease (COVID‐19) albeit with low certainty. Data in kidney transplant recipients (KTR) are still lacking. Methods This was a retrospective cohort of 57 moderate to severe COVID‐19 positive KTR in a single center who received RDV as a part of COVID‐19 management. No dose adjustments were done. The outcomes were measured as acute kidney injury (AKI) recovery; liver function tests abnormalities; other side effects; graft loss and death. Results The median (inter‐quartile range) age of presentation was 44 (31‐51) years. The duration from onset of symptoms to RDV initiation was 6 (5‐7) days. Thirty‐two (56%) cases received RDV on the day of admission. Forty‐six (81%) cases were on oxygen support upon initiation of RDV. Thirty‐eight (66.6%) cases had acute kidney injury on admission. The median baseline, admission, and 28‐day follow‐up serum creatinine of the cohort were 1.59 (1.1‐2.1), 2.13 (1.3‐3.1), and 1.58 (1.05‐2.1) mg/dl, respectively. A total of 8(14%) cases died in the study with 1 (1.7%) graft loss. All those cases that died were on oxygen therapy at the time of initiation of RDV. No liver function derangements or any other major adverse events with the drug were reported. Conclusion RDV therapy is safe and clinically feasible in renal transplant recipients as seen in our cohort. Larger clinical registries and randomized clinical trials should be conducted to further explore the efficacy in transplant recipients.

Introduction COVID-19 has drastically impacted the transplant services, but there is limited understanding the discrepancy in COVID-19 impact over various regions of the world. Methods We have explored the global observatory for organ donation and transplantation (GODT) data for assessing the transplant number changes between the calendar year 2019(n = 157301) and 2020(129681). Results There was disproportionate impact of COVID-19 for different areas of the world. Globally, there was a decline of 17.5%, in which deceased donation, kidney (20.9%), pancreas (16.2%), lung (12.7%), liver (11.3%) and heart (8%) transplantation declined disproportionally in different regions of the world. While pandemic affected almost all geographic regions and nations, but China and USA were mostly able to recover from the initial halt of the transplant practices by the pandemic, so that there was a cumulative increase in transplant numbers. Conclusion Our data, shows that developing nations lagged behind and developed nations have been able to recover their transplantation programs in the pandemic. Further policy making and preparedness is required to safeguard the most vulnerable areas of the world to minimize the impact of any future pandemic in transplantation practices.

Background There is a scarcity of data comparing the consequences of first and second COVID‐19 waves on kidney transplant recipients (KTRs) in India. Methods We conducted a single‐centre retrospective study of 259 KTRs with COVID‐19 to compare first wave (March 15–December 31 2020, n = 157) and second wave (April 1–May 31 2021, n = 102). Results KTRs during second wave were younger (43 vs. 40 years; p ‐value .04) and also included paediatric patients (0 vs. 5.9%; p ‐value .003). Symptoms were milder during the second wave (45 vs. 62.7%; p ‐value .007); COVID‐19 positive patients had less frequent cough (32 vs. 13.8%; p ‐value .001), fever was less frequent (58 vs. 37%; p ‐value .001), and we observed fewer co‐morbidities (11 vs. 20.6%; p ‐value .04). The percentages of neutrophils (77 vs. 83%; p ‐value .001) and serum ferritin (439 vs. 688; p ‐value .0006) were higher during second wave, while lymphocyte counts were reduced (20 vs. 14%; p ‐value .0001). Hydroxychloroquine (11 vs. 0%; p ‐value .0001) and tocilizumab (7 vs. 0%; p ‐value .004) were more frequently prescribed during first wave, while utilization of dexamethasone (6 vs. 27%; p ‐value .0001) and remdesivir (47 vs. 65%; p ‐value .03) increased during the second wave. Mucormycosis (1.3 vs. 10%; p ‐value .01) and ICU admissions (20 vs. 37.2%; p ‐value .002) were more frequent during second wave. The 28‐day mortality rate (9.6 vs. 10%; p ‐value 1) was not different. Conclusions There has been a different clinical spectrum of COVID‐19 amongst KTR with similar mortality between the two waves at a large Indian transplant centre.

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Background. There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. Methods. We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. Results. Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. Conclusions. Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.

Background We aimed to analyze the humoral and cellular response to standard and booster (additional doses) COVID‐19 vaccination in solid organ transplantation (SOT) and the risk factors involved for an impaired response. Methods We did a systematic review and meta‐analysis of studies published up until January 11, 2022, that reported immunogenicity of COVID‐19 vaccine among SOT. The study is registered with PROSPERO, number CRD42022300547. Results Of the 1527 studies, 112 studies, which involved 15391 SOT and 2844 healthy controls, were included. SOT showed a low humoral response (effect size [ES]: 0.44 [0.40–0.48]) in overall and in control studies (log‐Odds‐ratio [OR]: −4.46 [−8.10 to −2.35]). The humoral response was highest in liver (ES: 0.67 [0.61–0.74]) followed by heart (ES: 0.45 [0.32–0.59]), kidney (ES: 0.40 [0.36–0.45]), kidney‐pancreas (ES: 0.33 [0.13–0.53]), and lung (0.27 [0.17–0.37]). The meta‐analysis for standard and booster dose (ES: 0.43 [0.39–0.47] vs. 0.51 [0.43–0.54]) showed a marginal increase of 18% efficacy. SOT with prior infection had higher response (ES: 0.94 [0.92–0.96] vs. ES: 0.40 [0.39–0.41]; p ‐value < .01). The seroresponse with mRNA‐12723 mRNA was highest 0.52 (0.40–0.64). Mycophenolic acid (OR: 1.42 [1.21–1.63]) and Belatacept (OR: 1.89 [1.3–2.49]) had highest risk for nonresponse. SOT had a parallelly decreased cellular response (ES: 0.42 [0.32–0.52]) in overall and control studies (OR: −3.12 [−0.4.12 to −2.13]). Interpretation Overall, SOT develops a suboptimal response compared to the general population. Immunosuppression including mycophenolic acid, belatacept, and tacrolimus is associated with decreased response. Booster doses increase the immune response, but further upgradation in vaccination strategy for SOT is required.