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Case Reports
. 2021 Aug;21(8):2885-2889.
doi: 10.1111/ajt.16532. Epub 2021 Mar 15.

Donor to recipient transmission of SARS-CoV-2 by lung transplantation despite negative donor upper respiratory tract testing

Daniel R Kaul  1 , Andrew L Valesano  1 , Joshua G Petrie  2 , Rommel Sagana  3 , Dennis Lyu  3 , Jules Lin  4 , Emily Stoneman  1 , Lane M Smith  5 , Paul Lephart  6 , Adam S Lauring  7
Affiliations
Case Reports

Donor to recipient transmission of SARS-CoV-2 by lung transplantation despite negative donor upper respiratory tract testing

Daniel R Kaul et al. Am J Transplant. 2021 Aug.

Abstract

We describe a case of proven transmission of SARS-CoV-2 from lung donor to recipient. The donor had no clinical history or findings suggestive of infection with SARS-CoV-2 and tested negative by reverse transcriptase polymerase chain reaction (RT-PCR) on a nasopharyngeal (NP) swab obtained within 48 h of procurement. Lower respiratory tract testing was not performed. The recipient developed fever, hypotension, and pulmonary infiltrates on posttransplant day (PTD) 3, and RT-PCR testing for SARS-CoV-2 on an NP swab specimen was non-reactive, but positive on bronchoalveolar lavage (BAL) fluid. One thoracic surgeon present during the transplantation procedure developed COVID-19. Sequence analysis of isolates from donor BAL fluid (obtained at procurement), the recipient, and the infected thoracic surgeon proved donor origin of recipient and health-care worker (HCW) infection. No other organs were procured from this donor. Transplant centers and organ procurement organizations should perform SARS-CoV-2 testing of lower respiratory tract specimens from potential lung donors, and consider enhanced personal protective equipment for HCWs involved in lung procurement and transplantation.

Keywords: clinical research/practice; donors and donation: donor-derived infections; infection and infectious agents - viral; infectious disease.

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Figures

FIGURE 1
FIGURE 1
Phylogenetic analysis of the six sequences associated with this case [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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References

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