Long-term shedding of viable SARS-CoV-2 in kidney transplant recipients with COVID-19

Abstract

The exact duration of viable SARS-CoV-2 shedding in kidney transplant recipients (KTRs) remains unclear. Here, we retrospectively investigated this issue using cell cultures of SARS-CoV-2 RT-PCR-positive nasopharyngeal samples (n = 40) obtained from 16 KTRs with symptomatic COVID-19 up to 39 days from symptom onset. A length of viable SARS-CoV-2 shedding >3 weeks from the onset of symptoms was identified in four KTRs (25%). These results suggest that a significant proportion of KTRs can shed viable SARS-CoV-2 for at least 3 weeks, which may favor the emergence of new variants. Based on these data, we recommend prolonging the isolation of KTRs with COVID-19 until negative SARS-CoV-2 RT-PCR testing.

Keywords: clinical research/practice; complication: infectious; infection and infectious agents - viral; infectious disease; kidney transplantation/nephrology; translational research/science.

FIGURE 1

Duration of viral shedding in kidney transplant recipients (n = 16). (A) Results of viral culture in relation to the days from symptom onset for each kidney transplant recipient. A total of 40 nasopharyngeal specimens from 16 recipients were analyzed. Each sample was tested with (1) an RT-PCR-based assay targeting two different regions of the RNA-dependent RNA polymerase (RdRp) gene in accordance with the WHO technical guidance and (2) SARS-CoV-2 viral cell culture. Four patients (KTR6, KTR7, KTR8, and KTR11) were found to shed viable SARS-CoV-2 for at least 3 weeks from the onset of symptoms. (B) Presence (red dots) or absence (blue dots) of viable SARS-CoV-2 shedding (based on the results of viral culture) in relation to cycle threshold (CT) values and days after symptoms onset (DSO). KTR, kidney transplant recipient; RT-PCR, reverse transcription-polymerase chain reaction; SARS-CoV-2, severe acute respiratory distress syndrome coronavirus 2; WHO, World Health Organization [Color figure can be viewed at wileyonlinelibrary.com]