To the Editor:
We read “Kidney transplantation from a SARS‐CoV‐2‐positive donor for the recipients with immunity after COVID‐19” by Puodziukaite et al. with great interest. 1 This was a case report about the transplantation of two kidneys from a donor with active coronavirus disease 2019 (COVID‐19).
COVID‐19 pandemic has created new challenges for health care systems around the world and also has directly affected solid organ transplantation (SOT) including donation. 2 The ongoing pandemic has not decreased the need for SOT, and a global concern has been safe transplantation during this time. 3 During a pandemic, the potential organ donation pool should be affected, which raises the question of how to approach a possible donor with history of COVID‐19. One report mentioned the possibility of donor‐derived severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in lung transplantation that may affect all types of transplant recipients. 4 On the other hand, successful heart and liver transplant from SARS‐CoV‐2 polymerase chain reaction (PCR)‐positive donor has been reported. 5 This suggests there should potentially be a concern in lung transplantation, but still this is unclear in other transplants whether we can use these donors safely. We report successful kidney transplantation from nasopharyngeal (NP) swab PCR‐positive donor to two PCR‐negative recipients, and additional two recipients (one kidney and one liver) whose donor had active history of COVID‐19, but SARS‐CoV‐2 PCR achieved negativity at the time of procurement. We did not modify induction or maintenance immunosuppressive medication or add any SARS‐CoV‐2‐specific treatment despite of the donor PCR positivity. During surgery, SARS‐CoV‐2 infection precaution methods including wearing N95 masks and using negative pressure surgery rooms were implemented.
The donor was a 19‐year‐old male with no known history of SARS‐CoV‐2 infection. The cause of death was determined to be due to a gun shot. There was no documented evidence of respiratory symptoms. Chest x‐ray at the time of procurement was normal, and no chest CT was available. This donor had positive PCR result of NP swab for SARS‐CoV‐2 (Labcorp) with cycle threshold (Ct) value of 40.2. As the donor did not have any active symptoms consistent with COVID‐19 and Ct value was high, we proceeded with transplantation. Both kidneys were transplanted into two different recipients. Recipients’ information is summarized in Table 1. Patients had close follow‐up to 12 weeks after transplant with no evidence of symptomatic COVID‐19. Nine days after transplant, we did follow NP swab PCR and both of them were negative. Allograft function and overall clinical status has been optimal during follow‐up.
TABLE 1.
Recipient characteristics
| Case number | Age/Gender | Type of transplant | Primary disease for end‐stage kidney disease | Positive donor SARS‐CoV‐2NP swab immediately prior to transplant | SARS‐CoV‐2NP swab follow‐up after transplant | Follow‐up period (days) | Prior recipient vaccination | Induction immunosuppression | Graft outcome at last follow‐up | Upper respiratory like symptoms at follow‐up |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 33/Female | Kidney | Lupus nephritis | Yes | Negative/9 days after transplant | 84 | No | Thymoglobulin/basiliximab/methylprednisolon |
Cr 0.8 mg/dl BUN 17 mg/dl |
None |
| 2 | 21/Female | Kidney | Bilateral renal hypoplasia | Yes | Negative/9 days after transplant | 84 | 1 Week prior to transplant (first dose‐Pfizer) | Thymoglobulin/basiliximab/methylprednisolon |
Cr 0.69 mg/dl BUN 6 mg/dl |
None |
| 3 | 50/Female | Kidney | Atrophic kidneys | No | Negative/7 days after transplant | 58 | No | Thymoglobulin/basiliximab/methylprednisolon |
Cr 0.8 mg/dl BUN 13 mg/dl |
None |
| 4 | 22/Male | Liver | Autoimmune hepatitis | No | Negative/13 days after transplant | 35 | Yes (two doses‐Pfizer) | Methylprednisolone/antithymocyte/rituximab | Normal liver function test | None |
Abbreviations: BUN, blood urea nitrogen; Cr, creatinine; NP, nasopharyngeal; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2.
Similar to Puodziukaite et al., 1 we safely performed abdominal transplantations from a donor with positive PCR of NP swab for SARS‐CoV‐2. During a pandemic, to expand the donor pool, we may need to reassess utilization of organs from PCR‐positive donors for kidney transplantation, especially when there are no signs of active infection with high Ct value. To validate the safety of PCR‐positive donor in abdominal transplantation, a larger sample sized study should be needed.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.
AUTHOR CONTRIBUTIONS
Paola Frattaroli, Shweta Anjan, and Yoichiro Natori designed the study. All authors were responsible for data interpretation and writing.
REFERENCES
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