Solid Organ Transplantation From SARS-CoV-2–infected Donors to Uninfected Recipients: A Single-center Experience

Abstract

Background. The risk of donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in solid organ (heart, lung, liver, kidney, pancreas, and intestine) transplant recipients is poorly understood. Since hematogenous transmission of SARS-CoV-2 has not been documented to date, nonlung solid organs might be suitable for transplantation since they likely portend a low risk of viral transmission. Methods. Abdominal solid organs from SARS-CoV-2–infected donors were transplanted into uninfected recipients. Results. Between April 18, 2021, and October 30, 2021, we performed transplants of 2 livers, 1 simultaneous liver and kidney, 1 kidney, and 1 simultaneous kidney and pancreas from SARS-CoV-2–infected donors into 5 uninfected recipients. None of the recipients developed SARS-CoV-2 infection or coronavirus disease 2019, and when tested, allograft biopsies showed no evidence of SARS-CoV-2 RNA. Conclusions. Transplanting nonlung organs from SARS-CoV-2–infected donors into uninfected recipients demonstrated no evidence of virus transmission.

Utilization and outcomes of deceased donor SARS-CoV-2–positive organs for solid organ transplantation in the United States

“…These data complement prior smaller single‐center reports and case series and may provide assurance that, at least short‐term outcomes are not compromised by use of these organs. 7 , 8 , 9 , 10 , 11 , 13 , 20 , 21 In the context of kidney transplantation, the current study indicated no difference in rates of delayed graft function or 6‐month graft survival and the characteristics of recipients was similar between negative and positive SARS‐CoV‐2 status donors. Similarly for liver and transplant recipients, both general characteristics of recipients and 6‐month graft survival were similar by SARS‐CoV‐2 status donors.…”

COVID-19 positive donor for solid organ transplantation

“… 22 Since then, several transplants have been performed, most of which were liver, kidney, and (to a lesser extent) heart. To date, no cases of SARS-CoV-2 transmission after non-lung transplant have been reported 16 23 6 24 25 7 . 21…”

“…As of today, in our national experience with 71 organ transplants performed from donors with active SARS-CoV-2 infection and on the basis of current literature with overall 455 non-lung organs (278 kidneys, 125 livers, 41 hearts, and 11 pancreas) transplanted from donors with a positive lower respiratory tract SARS-CoV-2 test, no recipients acquired COVID-19 infection through non-lung transplantation. In contrast there have been three unexpected donor derived transmissions to lung recipients, because the donor tested negative for SARS-CoV-2 in an upper respiratory tract specimen but retrospectively tested positive in a LRT specimen 26 16 23 6 24 25 7 . 21…”

Organ transplantation using COVID-19-positive deceased donors

“…Despite these early recommendations, reports of organ transplantation using donors known to be actively infected with or recovered from COVID‐19 infection began to emerge. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Initial reports came from donors who had previously been infected with COVID‐19 but had subsequently recovered. Later cases included those with lower‐risk donors and recipients who either had a personal history of COVID‐19 infection in the past and/or had antibodies to COVID‐19 present.…”