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

doi:10.1093/ofid/ofac221

Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission Through Solid Organ Transplantation and Outcomes of Coronavirus Disease 2019 Among Recent Transplant Recipients

Open Forum Infect Dis. 2022 May 2;9(7):ofac221. doi: 10.1093/ofid/ofac221. eCollection 2022 Jul.

Affiliations

¹ COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
³ Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA.
⁴ Division of Transplantation, Health Systems Bureau, Health Resources and Services Administration, Rockville, Maryland, USA.
⁵ Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁶ United Network for Organ Sharing, Richmond, Virginia, USA.

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.

Keywords: COVID-19; LRT; SARS-CoV-2; SOT; donor-derived infection; lower respiratory tract; solid organ transplant; transplant-transmitted infection.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.