tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2022 May 2;9(7)
fac221.
doi: 10.1093/ofid/ofac221. eCollection 2022 Jul.
Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission Through Solid Organ Transplantation and Outcomes of Coronavirus Disease 2019 Among Recent Transplant Recipients
Rebecca J Free[SUP] 1 [/SUP], Pallavi Annambhotla[SUP] 1 [/SUP], Ricardo M La Hoz[SUP] 2 [/SUP], Lara Danziger-Isakov[SUP] 3 [/SUP], Jefferson M Jones[SUP] 1 [/SUP], Lijuan Wang[SUP] 1 [/SUP], Senthil Sankthivel[SUP] 1 [/SUP], Marilyn E Levi[SUP] 4 [/SUP], Marian G Michaels[SUP] 5 [/SUP], Wendi Kuhnert[SUP] 1 [/SUP], David Klassen[SUP] 6 [/SUP], Sridhar V Basavaraju[SUP] 1 [/SUP], Ian T Kracalik[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmissible through lung transplantation, and outcomes among infected organ recipients may be severe. Transmission risk to extrapulmonary organ recipients and recent (within 30 days of transplantation) SARS-CoV-2-infected recipient outcomes are unclear.
Methods: During March 2020-March 2021, potential SARS-CoV-2 transmissions through solid organ transplantation were investigated. Assessments included SARS-CoV-2 testing, medical record review, determination of likely transmission route, and recent recipient outcomes.
Results: During March 2020-March 2021, approximately 42 740 organs were transplanted in the United States. Forty donors, who donated 140 organs to 125 recipients, were investigated. Nine (23%) donors and 25 (20%) recipients were SARS-CoV-2 positive by nucleic acid amplification test (NAAT). Most (22/25 [88%]) SARS-CoV-2-infected recipients had healthcare or community exposures. Nine SARS-CoV-2-infected donors donated 21 organs to 19 recipients. Of these, 3 lung recipients acquired SARS-CoV-2 infections from donors with negative SARS-CoV-2 testing of pretransplant upper respiratory tract specimens but from whom posttransplant lower respiratory tract (LRT) specimens were SARS-CoV-2 positive. Sixteen recipients of extrapulmonary organs from SARS-CoV-2-infected donors had no evidence of posttransplant COVID-19. All-cause mortality within 45 days after transplantation was 6-fold higher among SARS-CoV-2-infected recipients (9/25 [36%]) than those without (6/100 [6%]).
Conclusions: Transplant-transmission of SARS-CoV-2 is uncommon. Pretransplant NAAT of lung donor LRT specimens may prevent transmission of SARS-CoV-2 through transplantation. Extrapulmonary organs from SARS-CoV-2-infected donors may be safely usable, although further study is needed. Reducing recent recipient exposures to SARS-CoV-2 should remain a focus of prevention.
Keywords: COVID-19; LRT; SARS-CoV-2; SOT; donor-derived infection; lower respiratory tract; solid organ transplant; transplant-transmitted infection.
. 2022 May 2;9(7)
fac221.doi: 10.1093/ofid/ofac221. eCollection 2022 Jul.
Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission Through Solid Organ Transplantation and Outcomes of Coronavirus Disease 2019 Among Recent Transplant Recipients
Rebecca J Free[SUP] 1 [/SUP], Pallavi Annambhotla[SUP] 1 [/SUP], Ricardo M La Hoz[SUP] 2 [/SUP], Lara Danziger-Isakov[SUP] 3 [/SUP], Jefferson M Jones[SUP] 1 [/SUP], Lijuan Wang[SUP] 1 [/SUP], Senthil Sankthivel[SUP] 1 [/SUP], Marilyn E Levi[SUP] 4 [/SUP], Marian G Michaels[SUP] 5 [/SUP], Wendi Kuhnert[SUP] 1 [/SUP], David Klassen[SUP] 6 [/SUP], Sridhar V Basavaraju[SUP] 1 [/SUP], Ian T Kracalik[SUP] 1 [/SUP]
Affiliations
- PMID: 35873294
- PMCID: PMC9297154
- DOI: 10.1093/ofid/ofac221
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmissible through lung transplantation, and outcomes among infected organ recipients may be severe. Transmission risk to extrapulmonary organ recipients and recent (within 30 days of transplantation) SARS-CoV-2-infected recipient outcomes are unclear.
Methods: During March 2020-March 2021, potential SARS-CoV-2 transmissions through solid organ transplantation were investigated. Assessments included SARS-CoV-2 testing, medical record review, determination of likely transmission route, and recent recipient outcomes.
Results: During March 2020-March 2021, approximately 42 740 organs were transplanted in the United States. Forty donors, who donated 140 organs to 125 recipients, were investigated. Nine (23%) donors and 25 (20%) recipients were SARS-CoV-2 positive by nucleic acid amplification test (NAAT). Most (22/25 [88%]) SARS-CoV-2-infected recipients had healthcare or community exposures. Nine SARS-CoV-2-infected donors donated 21 organs to 19 recipients. Of these, 3 lung recipients acquired SARS-CoV-2 infections from donors with negative SARS-CoV-2 testing of pretransplant upper respiratory tract specimens but from whom posttransplant lower respiratory tract (LRT) specimens were SARS-CoV-2 positive. Sixteen recipients of extrapulmonary organs from SARS-CoV-2-infected donors had no evidence of posttransplant COVID-19. All-cause mortality within 45 days after transplantation was 6-fold higher among SARS-CoV-2-infected recipients (9/25 [36%]) than those without (6/100 [6%]).
Conclusions: Transplant-transmission of SARS-CoV-2 is uncommon. Pretransplant NAAT of lung donor LRT specimens may prevent transmission of SARS-CoV-2 through transplantation. Extrapulmonary organs from SARS-CoV-2-infected donors may be safely usable, although further study is needed. Reducing recent recipient exposures to SARS-CoV-2 should remain a focus of prevention.
Keywords: COVID-19; LRT; SARS-CoV-2; SOT; donor-derived infection; lower respiratory tract; solid organ transplant; transplant-transmitted infection.