Dataset Information

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

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.

SUBMITTER: Martinez-Reviejo R

PROVIDER: S-EPMC9074299 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThis is a descriptive study to characterize rates of SARS-CoV-2 infection in pediatric solid organ transplant (SOT) recipients during the early days of the pandemic. We hypothesized that asymptomatic infection may represent a large proportion of SARS-CoV-2 infection in ped SOT recipients.MethodsWe queried OTTR for all pediatric SOT recipients followed at our center and reviewed medical records to identify patients tested for SARS-CoV-2 between March 15, 2020 through June 30, 2021. Patients were tested by PCR: prior to planned procedures or because of symptoms; OR: tested by measurement of IgG to spike protein with their routine labs q 2-monthly. A positive PCR was called acute infection. A positive IgG with negative PCR was called convalescence. For immunologic studies, blood was obtained when the PCR or IgG was positive. Statistical comparisons were made between (i) acute infection vs. convalescence; (ii) acute infection vs. SOT recipients without infection (called healthy controls); (iii) LT vs. SB/MVT; (iii) positive vs. negative test result.ResultsOf 257 liver transplant (LT) recipients, 99 were tested: 6 were PCR positive,13 were antibody positive. Of 150 small bowel (SB)/ multi-visceral transplant (MVT) recipients, 55 were tested: 4 were PCR positive, 6 were antibody positive. Of 8 simultaneous liver, kidney transplant recipients, 3 were tested: 1 was PCR positive. Symptoms when present were mostly mild. Patients with a positive test result were younger (6.3 vs. 10.0-years; p=0.017). We observed a rapid decline in viral load within 96-hours without a change in immunosuppression. Antibody lasted >8-months beyond the time it was monitored. Acute infection was associated with increased CD4 and CD8 TEM cell frequency (p=0.04, p=0.03 respectively), decreased IFN-γ production from T-cells (2.8% vs.11.3% p=0.006), and decreased CD8 TEMRA frequency (4.56% vs.11.70% p=0.006).ConclusionEarly in the pandemic, COVID-19 disease was mostly mild in pediatric SOT recipients with no rejection, patient death, or graft loss observed.