Utilization and Outcomes of Deceased Donor SARS-CoV-2–Positive Organs for Solid Organ Transplantation in the United States

Jesse D. Schold; Christine E. Koval; Alvin Wee; Mohamed Eltemamy; Emilio D. Poggio

Disclosures

American Journal of Transplantation. 2022;22(9):2217-2227. 

In This Article

Abstract and Introduction

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.

Introduction

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.[6] 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).

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