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, Pallavi Annambhotla, Ricardo M. La Hoz, Lara Danziger-Isakov, Jefferson M. Jones, Lijuan Wang, Senthil Sankthivel, Marilyn E. Levi, Marian G. Michaels, Wendi Kuhnert, David Klassen, Sridhar V. Basavaraju, Ian T. Kracalik

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article numberofac221
JournalOpen Forum Infectious Diseases
Volume9
Issue number7
DOIs
StatePublished - Jul 1 2022

Keywords

  • COVID-19
  • donor-derived infection
  • lower respiratory tract
  • LRT
  • SARS-CoV-2
  • solid organ transplant
  • SOT
  • transplant-transmitted infection

ASJC Scopus subject areas

  • Oncology
  • Infectious Diseases

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