Abstract
The aim of this prospective study was to assess the duration of culture-viable SARS-CoV-2 and to monitor the emergence of mutations in a cohort of 23 kidney transplant recipients (KTRs) from June 2022 to June 2023. Combined nares/oropharyngeal swabs were performed weekly starting as soon as possible after symptom onset. The time from symptom onset to a negative culture was (11 days (IQR 8-14), while time to negative RT-qPCR was 18 days (IQR 15-30). 21.7% had a positive culture beyond the first swab and 8.7% replicated viable virus for longer than 30 days. T-cell depletion (rate ratio 2.5, 95% CI 1.9, 3.3; p<0.001) and time from transplantation (rate ratio 0.93, 95% CI 0.90, 0.97; p=0.006) were associated with time of viable virus shedding. A cycle threshold (Ct) value of 24.2 demonstrated a 91.3% negative predictive value of viability (95% CI 76, 100). The odds of viability decreased by 69% per week of infection (OR 0.31, 95% CI 0.12, 0.76). Overall, RNA sequencing did not show accelerated molecular evolution though mutation rate could be increased in molnupiravir-treated KTRs. In conclusion, viable SARS-CoV-2 is eliminated rapidly, risk of virus evolution is low, and prolonged self-isolation is generally unnecessary for most KTRs.
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