Nonlung Solid Organ Transplantation from SARS-CoV-2–Positive Donors: Implications for Post-transplant Surveillance and Outcomes

Abstract

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a profound deleterious impact on solid organ transplantation (SOT) rates. There is limited evidence on the risk of donor-recipient SARS-CoV-2 transmission in nonlung SOT. METHODS: We performed a prospective IRB-approved descriptive study of nonlung SOT from SARS-CoV-2–positive donors to uninfected recipients between June 2021 and February 2022. We report donor and recipient characteristics, SARS-CoV-2–related testing and treatment, and short-term outcomes. RESULTS: Eighteen recipients had SOT from 17 SARS-CoV-2–positive donors, including 11 kidneys, 4 livers, and 4 hearts. Median follow-up was 63 days. Donors tested positive by lower respiratory or nasopharyngeal reverse transcriptase-polymerase chain reaction (RT-PCR). Cycle thresholds were reported for 59% of donors and ranged from 17.1 to 41.9. Causes of death were: drug intoxication (41%), cardiovascular (29%), blunt trauma (18%), stroke (6%), and gunshot wounds (6%). One donor was treated with monoclonal antibody casirivimab/imdevimab. All recipients had negative SARS-CoV-2 nasopharyngeal RT-PCR before SOT, and 17 of 18 patients had 2- or 3-dose mRNA vaccination pretransplant. Monoclonal antibody prophylaxis was given to 7 recipients. Routine RT-PCR testing was performed post-transplant in 17 of 18 patients. Two recipients tested positive on postoperative day 8 but developed no symptoms. All recipient grafts remain viable, and no recipients developed SARS-CoV-2–related illness. CONCLUSION: Transplantation of nonlung solid organs from SARS-CoV-2–positive donors to uninfected recipients can be performed safely.