Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping?

Abstract

COVID‐19 pandemic dramatically impacted transplantation landscape. Scientific societies recommend against the use of donors with active SARS‐CoV‐2 infection. Italian Transplant Authority recommended to test recipients/donors for SARS‐CoV‐2‐RNA immediately before liver transplant (LT) and, starting from November 2020, grafts from deceased donors with active SARS‐CoV‐2 infection were allowed to be considered for urgent‐need transplant candidates with active/resolved COVID‐19. We present the results of the first 10 LTs with active COVID‐19 donors within an Italian multicenter series. Only two recipients had a positive molecular test at LT and one of them remained positive up to 21 days post‐LT. None of the other eight recipients was found to be SARS‐CoV‐2 positive during follow‐up. IgG against SARS‐CoV‐2 at LT were positive in 80% (8/10) of recipients, and 71% (5/7) showed neutralizing antibodies, expression of protective immunity related to recent COVID‐19. In addition, testing for SARS‐CoV‐2 RNA on donors’ liver biopsy at transplantation was negative in 100% (9/9), suggesting a very low risk of transmission with LT. Immunosuppression regimen remained unchanged, according to standard protocol. Despite the small number of cases, these data suggest that transplanting livers from donors with active COVID‐19 in informed candidates with SARS‐CoV‐2 immunity, might contribute to safely increase the donor pool.

Successful Liver Transplantation From a SARS-CoV-2 Positive Donor to a Positive Recipient: Potential Role of Monoclonal Antibodies

“…Simultaneously, there was uncertainty about safety of transplanting a recipient with coronavirus disease 2019 (COVID-19). Although there are emerging reports of liver transplantation from SARS-CoV-2-infected deceased donors, 2 optimal risk mitigation strategies are unclear. Herein, we report a case of liver transplantation from a SARS-CoV-2 positive deceased donor to a SARS-CoV-2 positive recipient who was managed with anti spike monoclonal antibodies.…”

Short‐term liver transplant outcomes from SARS‐CoV‐2 lower respiratory tract NAT positive donors

“…Five of them had a positive LRT SARS-CoV-2 NAT at the time of organ recovery without a history of COVID-19;there was no clinical evidence of donor-derived COVID-19 on followup. The Ct values for the positive LRT samples in those donors were not described 12. The OPTN has monitored the implications of its emergency policy.…”

Seroconversion After Coronavirus Disease 2019 Vaccination in Patients Awaiting Liver Transplantation: Fact or Fancy?

“…(5,14,24) Furthermore, the increasing number of vaccinated LT candidates might allow the use of precious organs from donors with active COVID-19 infection. (25) The main limitations of this study are the monocentric even if multiregional enrollment, the small number of patients, the low median MELD score, the different elapsed time between vaccination and IgG tests in the pre-LT and control groups, and the lack of long-term post-LT follow-up, but we believe that preliminary data are necessary to support our ongoing everyday policy with very fragile pretransplant candidates.…”