Comparison of Short-Term Outcomes in Kidney Transplant Recipients from SARS-CoV-2–Infected versus Noninfected Deceased Donors

Abstract

Background Acceptable posttransplant outcomes were reported in kidney transplant recipients from donors with coronavirus disease-2019 (COVID-19), however, there are no comparative studies with well-matched controls. Methods This multicenter, prospective observational study, which included three transplant centers in the US, enrolled 61 kidney recipients from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected deceased donors. Using optimal matching methods, we matched every recipient to three comparators receiving kidneys from SARS-CoV-2-negative deceased donors with otherwise highly similar characteristics within the same transplant centers to compare 6-month eGFR. Results Among recipients of SARS-CoV-2-infected donor kidneys, one recipient died with a functional graft within 6 months. Mean 6-month eGFR was not significantly different between SARS-CoV-2-infected and non-infected donor groups (55±21 and 57±25 mL/min/1.73m2; p=0.61). Six-month eGFR in recipients from SARS-CoV-2-infected donors who died from reasons other than COVID-19 was not significantly different from those from SARS-CoV-2-negative donors (58±22 and 56±25 mL/min/1.73m2; p=0.51). However, recipients from donors who died from COVID-19 had significantly lower 6-month eGFR that those from SARS-CoV-2-negative donors (46±17 and 58±27 mL/min/1.73m2; p=0.03). No donor-to-recipient SARS-CoV-2 transmission was observed. Conclusions Six-month eGFR was not significantly different between recipients of kidneys from SARS-CoV-2-infected and non-infected donors. However, those receiving kidneys from donors who died from COVID-19 had significantly lower 6-month eGFR. Donor-to-recipient SARS-CoV-2 transmission was not observed.

Should I Take a Transplant Kidney from a Person with COVID Infection?

“…As a patient advocate, I was invited to write a commentary regarding the article "Comparison of Short-Term Outcomes in Kidney Transplant Recipients from SARS-CoV-2-Infected versus Noninfected Deceased Donors," published in this issue of CJASN. 1 I think some context about myself may be helpful. I was born with CKD due to vesicoureteral reflux or kidney reflux.…”

Kidney Transplantation from SARS-CoV-2–Infected Deceased Donors

“…On this background, a carefully controlled, prospective study published in this issue of CJASN sheds new light on the outcomes of kidney transplantation from SARS-CoV-2-infected donors in contemporary practice. 6 In a prospective, observational cohort study of 61 vaccinated recipients from 52 SARS-CoV-2 PCR-positive donors at three US transplant centers, Yamauchi et al used optimal matching methods to match each recipient to three control recipients from noninfected deceased donors from January 2016 to May 2022 at the same center. 6 Final cohorts were well balanced across an array of recipient and donor factors, although year of transplantation in cases and controls was not reported.…”

“…All recipients in the study by Yamauchi et al were vaccinated before transplant, with 97% having received at least two doses of mRNA vaccines. 6 The ongoing emergence of novel variants of the SARS-CoV-2 highlights the importance of prevention and adherence to current vaccinations among transplant candidates before transplant and immunosuppression. 9 New variants may have increased transmissibility, high disease severity, and decreased response to treatments, and the community should advocate for inclusion of immunocompromised patients in studies of vaccines and therapeutics.…”

“…10 At this time, we believe organ acceptance from donors with COVID-19 may proceed with caution for vaccinated recipients who receive patient-centered education. Ongoing data collection, analysis, and reporting from retrospective and highquality prospective experience such as the work by Yamauchi et al 6 remain critical to guide the best use of available kidneys while protecting patient safety, even in the midst of novel and evolving public health challenges.…”

“…6 In a prospective, observational cohort study of 61 vaccinated recipients from 52 SARS-CoV-2 PCR-positive donors at three US transplant centers, Yamauchi et al used optimal matching methods to match each recipient to three control recipients from noninfected deceased donors from January 2016 to May 2022 at the same center. 6 Final cohorts were well balanced across an array of recipient and donor factors, although year of transplantation in cases and controls was not reported. Among the findings, one recipient from a SARS-CoV-2-infected donor died with graft function at 6 months, but mean 6-month recipient eGFR and patient and graft survival were not significantly different between the well-matched recipients from SARS-CoV-2-infected and noninfected donors.…”