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

Abstract

Coronavirus disease‐19 has had a marked impact on the transplant population and processes of care for transplant centers and organ allocation. Several single‐center studies have reported successful utilization of deceased donors with positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) tests. Our aims were to characterize testing, organ utilization, and transplant outcomes with donor SARS‐CoV‐2 status in the United States. We used Scientific Registry of Transplant Recipients data from March 12, 2020 to August 31, 2021 including a custom file with SARS‐CoV‐2 testing data. There were 35 347 donor specimen SARS‐CoV‐2 tests, 77.5% upper respiratory samples, 94.6% polymerase chain reaction tests, and 1.2% SARS‐CoV‐2–positive tests. Donor age, gender, history of hypertension, and diabetes were similar by SARS‐CoV‐2 status, while positive SARS‐CoV‐2 donors were more likely African‐American, Hispanic, and donors after cardiac death ( p ‐values <.01). Recipient demographic characteristics were similar by donor SARS CoV‐2 status. Adjusted donor kidney discard (odds ratio = 2.08, 95% confidence interval [CI] 1.66–2.61) was higher for SARS‐CoV‐2–positive donors while donor liver (odds ratio = 0.44, 95% CI 0.33–0.60) and heart recovery (odds ratio = 0.44, 95% CI 0.31–0.63) were significantly reduced. Overall post‐transplant graft survival for kidney, liver, and heart recipients was comparable by donor SARS‐CoV‐2 status. Cumulatively, there has been significantly lower utilization of SARS‐CoV‐2 donors with no evidence of reduced recipient graft survival with variations in practice over time.

Comparative outcomes for over 100 deceased donor kidney transplants from SARS-CoV-2 positive donors: A single-center experience

“…However, the use of extra‐pulmonary organs from the same donors has resulted in no clinical signs of donor‐derived SARS‐CoV‐2 and no reported ill‐ effects on allograft or patient outcomes 9,11 . Case reports, small case series and now recent summative OPTN data of liver, kidney and heart transplantation from donors with SARS‐CoV‐2 detection have been published with excellent recipient outcomes 12–25 . While the OPTN data is supportive of the safe use of organs from donors with SARS‐CoV‐2 detection, donor and recipient details that may illustrate the likelihood of active infection or infection‐related complications are lacking 25 …”

A novel gene signature based on the hub genes of COVID-19 predicts the prognosis of idiopathic pulmonary fibrosis

“…The results of KEGG and GO pathway enrichment indicated that those genes were mostly enriched in DNA replication, immunomodulation, and energy metabolism. Increasing studies of COVID-19 patients showed that SARS-Cov-2 infects and replicates in endothelial cells in multiple organs, such as the heart, lung, kidney, and liver ( Dashtban et al, 2022 ; Giovannini et al, 2022 ; John et al, 2022 ; Kumar et al, 2022 ; Schold et al, 2022 ; Zheng et al, 2022 ). In addition, the enriched pathway p53 signaling was identified as a key pathway of genomic stability and cell cycle progression, it even plays a great part in the suppression of viral replication ( Kumar et al, 2022 ).…”

COVID-19: Has the Liver Been Spared?

“…Moreover, to date, there have been no reports of recognized transmissions of SARS-CoV-2 following blood transfusion, even in immunosuppressed patients [ 196 , 197 ]. Therefore, although, the number of transplants reported from positive SARS-CoV-2 donors is still relatively small, there is no clear evidence of additional risk to allograft survival [ 198 ].…”