Solid Organ Transplantation in SARS-CoV-2 Recovered Transplant Candidates: a Comprehensive Review of Recent Literature

Abstract

Purpose of Review As the coronavirus disease 2019 (COVID-19) pandemic continues to surge, determining the safety and timing of proceeding with solid organ transplantation (SOT) in transplant candidates who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and who are otherwise transplant eligible is an important concern. We reviewed the current status of protocols and the outcomes of SOT in SARS-CoV-2 recovered patients. Recent Findings We identified 44 published reports up through 7 September 2021, comprising 183 SOT [kidney = 115; lung = 27; liver = 36; heart = 3; simultaneous pancreas-kidney (SPK) = 1, small bowel = 1] transplants in SARS-CoV-2 recovered patients. The majority of these were living donor transplants. A positive SARS-CoV-2 antibody test, although not obligatory in most reports, was a useful tool to strengthen the decision to proceed with transplant. Two consecutive real-time polymerase chain test (RT-PCR) negative tests was one of the main prerequisites for transplant in many reports. However, some reports suggest that life-saving transplantation can proceed in select circumstances without waiting for a negative RT-PCR. In general, the standard immunosuppression regimen was not changed. Summary In select cases, SOT in COVID-19 recovered patients appears successful in short-term follow-up. Emergency SOT can be performed with active SARS-CoV-2 infection in some cases. In general, continuing standard immunosuppression regimen may be reasonable, except in cases of inadvertent transplantation with active SARS-CoV-2. Available reports are predominantly in kidney transplant recipients, and more data for other organ transplants are needed.

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

“…This perceived risk may be changing over time with greater acceptance in contemporary practice but may illustrate lost opportunities for transplants during the initial phases of the COVID‐19 pandemic. 24 Similarly, positive SARS‐CoV‐2 donor livers and hearts were significantly less likely to be recovered. In a context in which transplantation is largely the exclusive option for life‐sustaining therapy, these donor organs that were not recovered may also reflect missed transplant opportunities.…”

“…This suggests that donations that may have been beneficial to candidates may have been lost either to logistical challenges or perceived risk associated with positive SARS‐CoV‐2 status. This perceived risk may be changing over time with greater acceptance in contemporary practice but may illustrate lost opportunities for transplants during the initial phases of the COVID‐19 pandemic 24 . Similarly, positive SARS‐CoV‐2 donor livers and hearts were significantly less likely to be recovered.…”

Evolving Policies and Practices for Organ Recovery and Non- Lung Organ Transplantation in Candidates Recovering from COVID-2019 - A Review

“…This practical approach matches SOT risk tolerance to recipient acuity, and inexorably results in nonuniform local practices. To our best knowledge we reported the first two cases of liver transplant in SARS-CoV-2 PCR positive convalescing candidates [1]; case-reports and case-series of all abdomino-thoracic SOTs performed in PCR-positive convalescing recipients followed suit from across the globe, and usually with favorable outcomes [19][20][21][22][23][24][25][26][27][28]. In addition, larger series of SOT in SARS-CoV-2 PCR negative convalescing candidates ascertained the safety of transplantation within days or weeks after COVID-19 infection [29][30][31][32][33].…”

Organ Recovery and Non-Lung Organ Transplantation in Candidates Recovering from COVID-2019

“…3 In addition, larger series of transplantation in SARS-CoV-2 PCR negative convalescing candidates ascertained the safety of transplantation within days or weeks after COVID-19 infection. 4 The recent report by Shetty et al published in Progress in Transplantation underscores the unique challenges and considerations of liver transplantation in COVID-19 recovering recipients. 5 The authors point to a plausible synergy between the prothrombotic proclivities of COVID-19 and acutely decompensating cirrhosis that may culminate in perioperative thromboembolic complications.…”

“…3 In addition, larger series of transplantation in SARS-CoV-2 PCR negative convalescing candidates ascertained the safety of transplantation within days or weeks after COVID-19 infection. 4…”