Kidneys from deceased donors with COVID-19 do not negatively impact early patient survival
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Solid organ transplantation, including kidneys, using deceased donors infected with COVID-19 does not negatively impact early patient survival, according to data published in the American Journal of Transplantation.
“The Organ Procurement and Transplant Network (OPTN) has provided updated recommendations regarding the acceptance of organs from deceased donors with positive testing or a history of COVID-19. They state that the risk of transmission of the virus from donors with a history of COVID-19 greater than 21days prior to organ recovery is low but recommend caution in accepting these organs,” Matthew J. Bock, MD, a pediatric cardiologist at the University of California at San Diego, and colleagues wrote. They added, “Despite these reports and recommendations, there have been few large series of COVID-19-positive donors with a short duration of follow-up in all cases. The OPTN database now contains COVID-19 test results for all potential donors, since the start of the pandemic, allowing for a larger scale evaluation of outcomes in this population.”
In a retrospective cohort study, researchers examined data for 17,694 deceased solid organ transplant donors with available COVID-19 nucleic acid test (NAT) results between March 15, 2020, and Sept. 30, 2021. Researchers matched all donors to a recipient and stratified the cohorts by COVID-19 test results. Data were derived from the OPTN database.
Researchers considered death across all organs to be the primary endpoint of the study. Using Cox proportional hazards models, researchers measured independently significant risk factors for patient survival.
Overall, 150 deceased donors had positive COVID-19 results; 17,167 had negative COVID-19 results; and 377 had indeterminate or pending results. Researchers identified a total of 269 organs that were transplanted from these donors, including 187 kidneys, 57 livers, 18 hearts, five kidney-pancreases and two lungs. Among these transplantations, researchers observed eight graft failures and five deaths.
Analyses revealed the 30-day survival of a patient receiving an organ from a COVID-19-positive donor was 99.2%, whereas the 30-day survival for those receiving an organ from a COVID-19-negative donor was 98.6%.
“Solid organ transplantation using grafts from a cohort of deceased donors with positive COVID-19 NAT results did not negatively affect early post-transplant patient or graft survival. Though these results are reassuring, the lack of granular data in the OPTN database regarding many aspects of donor selection, including the extent and timing of COVID-19 infection in these donors, must be considered. To fully understand the risks involved with the utilization of COVID-19 NAT-positive donors, expanded data collection must be undertaken to address many of the limitations of this study.”
According to the researchers, limitations of the study include a small proportion of potential COVID-19-positive donors, lack of thorough patient follow-up and limited data on organs other than kidneys and livers.
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