Abstract and Introduction
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.
The transplant population has been disproportionally affected by the coronavirus disease-19 (COVID-19) pandemic. Transplant candidates and recipients have had higher rates of COVID-19 mortality than the general population and are particularly vulnerable to COVID-19 infection.[1–5] In addition to the direct effects of COVID-19 on the transplant patient population, processes of care for organ donation and allocation of donor organs have also been impacted. Early access to testing and logistical impediments had adverse effect on identifying potential deceased donors that may have been affected by SARS-CoV-2. With the exception of lung transplantation, the mechanisms of potential transmission of infection by organ donation have remained theoretical.[7–9] Due to ongoing uncertainties regarding the relative risks of transplantation with donors with prior or active infections, evidence for the safe use of organs from SARS-CoV-2–positive donors has emerged slowly with small case series from individual centers.[8,10–16] Although early results appear promising, best practices for utilization of positive SARS-CoV-2 donors remain unclear.[7–9,11,17–19]
In the current study, our aims were to characterize processes of care and outcomes associated with SARS-CoV-2 donation and transplantation in the United States. We sought to evaluate the incidence and type of SARS-CoV-2 testing over time. In addition, we intended to evaluate the utilization of donor organs with positive SARS-CoV-2 tests and deceased donor and recipient characteristics associated with SARS-CoV-2 status. Finally, we evaluated outcomes of recipients based on presence of donor SARS-CoV-2 testing and variation in procurement of positive SARS-CoV-2 donor organs by Organ Procurement Organizations (OPOs).
American Journal of Transplantation. 2022;22(9):2217-2227. © 2022 Blackwell Publishing