Utilization of SARS‐CoV‐2‐Positive donors in pediatric renal transplantation

Abstract

Background As COVID‐19‐positive donors are becoming more common, there is an increasing need for the transplant community to evaluate the safety and efficacy of organ transplant from a SARS‐CoV‐2‐infected donor. Methods Here we describe outcomes of two pediatric kidney transplant recipients who were vaccinated against COVID‐19 and received their allograft from a SARS‐CoV‐2‐positive donor. Results Both donors did not die from a COVID‐19‐related illness; the first donor had 1 week of COVID‐19 symptoms 4 weeks prior to donation and the second was asymptomatic. Donor 1 had a Ct of 33.4 at 3 days and Donor 2 with a Ct of 37.2 at 16 days prior to donation. The first recipient was positive for SARS‐CoV‐2 anti‐spike IgG on the day of transplant, but the second patient was negative and both patients received IVIg perioperatively. There was no evidence of SARS‐CoV‐2 transmission or compromised renal function at 86‐ and 80‐day post‐transplant, respectively. Conclusions This case series suggests favorable short‐term outcomes with accepting SARS‐CoV‐2‐positive donors for pediatric renal transplantation, after thorough evaluation of the donor's risk for transmission, assessing the recipient's serologic status to SARS‐CoV‐2, and considering pre‐emptive measures to mitigate the risk for severe COVID‐19 should the recipient acquire donor‐derived SARS‐CoV‐2.

The SARS‐CoV‐2‐positive donor in pediatric organ transplantation

“…2,3 In the current issue of the Journal, two centers describe their experiences with using SARS-CoV-2 positive donors in non-lung pediatric solid organ transplantation (SOT). 4,5 These reports provide important insights on positive donors, only one lung transplant recipients developed COVID-19 potentially from a donor organ. 6 Although three cases of COVID-19 occurred in lung transplant recipients, two were thought to be due to secondary transmission events (one from a healthcare worker documented by whole genome sequencing, and one from a family member).…”

“…Pizzo et al reported successful short‐term outcomes in two pediatric kidney transplant recipients from asymptomatic SARS‐CoV‐2‐positive donors, with no recipients having developed COVID‐19 after SOT. 5 Both donors were found to have positive SARS‐CoV‐2 PCR by nasopharyngeal swab with high C t values (33.4 and 37.2 at 3 and 16 days prior to donation), and negative tracheal SARS‐CoV‐2 PCR, making remote infection more likely as the trend in C t value was increasing with time; further declines in viral load expected by the time of organ donation, which may in part explain the lack of transmission from SOT. Interestingly, the second donor in the report by Clark et al was managed using monoclonal antibodies (casirivimab/imdevimab) and remdesivir prior to organ recovery.…”

“…Although there have now been reports on the outcomes of transplantation using organs from donors with a positive SARS‐CoV‐2 polymerase chain reaction (PCR) test in adults, data are limited in the pediatric population 2,3 . In the current issue of the Journal, two centers describe their experiences with using SARS‐CoV‐2 positive donors in non‐lung pediatric solid organ transplantation (SOT) 4,5 . These reports provide important insights on the clinical trajectory of children who have received an organ from a SARS‐CoV‐2 positive donor, contributing to the data needed to inform potential strategies for organ allocation in pediatric populations in the context of ongoing SARS‐CoV‐2 circulation.…”