Solid organ transplantation from donors with recent or current SARS-CoV-2 infection: A systematic review

Raquel Martinez-Reviejo; Sofia Tejada; Ana Cipriano; Hanife Nur Karakoc; Oriol Manuel; Jordi Rello

doi:10.1016/j.accpm.2022.101098

Solid organ transplantation from donors with recent or current SARS-CoV-2 infection: A systematic review

Anaesth Crit Care Pain Med. 2022 Aug;41(4):101098. doi: 10.1016/j.accpm.2022.101098. Epub 2022 May 6.

Authors

Raquel Martinez-Reviejo¹, Sofia Tejada², Ana Cipriano³, Hanife Nur Karakoc⁴, Oriol Manuel⁵, Jordi Rello⁶

Affiliations

¹ Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
² Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: stmagraner@gmail.com.
³ Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ Karadeniz Technical University School of Medicine, Trabzon, Turkey.
⁵ Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Transplantation Centre, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁶ Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain; Clinical Research, CHRU Nimes, Nimes, France.

Abstract

Background: Solid-organ transplantation (SOT) from SARS-CoV-2 positive donors could be a life-saving opportunity worth grasping. We perform a systematic review to evaluate the recipient outcomes of SOT from donors with recent or current SARS-CoV-2 infection.

Methods: Search strategy was performed in PubMed, Cochrane COVID-19 Study Register, and Web of Science databases from the 1^st of January 2019 to the 31^st of December 2021. SOT adult recipients from a donor with past or current SARS-CoV-2 infection were elegible for inclusion. Outcomes were viral transmission, COVID-19 symptoms, mortality, hospital stay, and complications. PROSPERO Register Number: CRD42022303242 FINDINGS: Sixty-nine recipients received 48 kidneys, 18 livers and 3 hearts from 57 donors. Six additional transplants from positive lungs were identified. IgG+ anti-SARS-CoV-2 titers were detected among 10/16 recipients; only 4% (3/69) recipients were vaccinated. Non-lung transplant recipients received organs from 10/57 (17.5%) donors with persistent COVID-19. In 18/57 donors, SARS-CoV-2 RNA was detected (median 32 Cycle threshold [Ct]) at procurement. Among non-lung transplant recipients, SARS-CoV-2 viral transmission was not documented. Four patients presented delayed graft dysfunction, two patients acute rejection, and two patients died of septic shock. The median (IQR) hospital stay was 18 (11-28) days in recipients from symptomatic donors. Viral transmission occurred from three lung donors to their recipients, who developed COVID-19 symptoms. One of the recipients subsequently died.

Conclusion: Use of non-lung (kidney, liver and heart) organs from SARS-CoV-2 positive donors seem to be a safe practice, with a low risk of transmission irrespective of the presence of symptoms at the time of procurement. Low viral replication (Ct > 30) was safe among non-lung donors, even if persistently symptomatic at procurement.

Keywords: COVID-19; Organ donation; Solid organ transplantation; Viral transmission.

Publication types

Review
Systematic Review

MeSH terms

Adult
COVID-19*
Humans
Organ Transplantation*
RNA, Viral
SARS-CoV-2
Tissue Donors

Substances

RNA, Viral