Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 2;9(7):ofac221.
doi: 10.1093/ofid/ofac221. eCollection 2022 Jul.

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  1 , Pallavi Annambhotla  1 , Ricardo M La Hoz  2 , Lara Danziger-Isakov  3 , Jefferson M Jones  1 , Lijuan Wang  1 , Senthil Sankthivel  1 , Marilyn E Levi  4 , Marian G Michaels  5 , Wendi Kuhnert  1 , David Klassen  6 , Sridhar V Basavaraju  1 , Ian T Kracalik  1
Affiliations

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 et al. Open Forum Infect Dis. .

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart displaying the 40 donors, and associated recipients and organs procured, referred to the Organ Procurement and Transplantation Network's Ad Hoc Disease Transmission Advisory Committee for investigation during March 2020–March 2021. Abbreviations: COVID-19, coronavirus disease 2019; DTAC, Disease Transmission Advisory Committee; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid amplification test discrepant results in 14 donors. Tests are denoted by the day of collection relative to organ procurement and recipient transplantation. Some tests were collected at an earlier date and tested retrospectively. *SARS-CoV-2 assays or testing platforms identified by the United States Food and Drug Administration as having a risk of inaccurate results. Abbreviations: FDA, Food and Drug Administration; LRT, lower respiratory tract; URT, upper respiratory tract.
See this image and copyright information in PMC

References

    1. Kaul DR, Valesano AL, Petrie JG, et al. Donor to recipient transmission of SARS-CoV-2 by lung transplantation despite negative donor upper respiratory tract testing. Am J Transplant 2021; 21:2885–9. - PMC - PubMed
    1. Kumar D, Humar A, Keshavjee S, Cypel M. A call to routinely test lower respiratory tract samples for SARS-CoV-2 in lung donors. Am J Transplant 2021; 21:2623. - PMC - PubMed
    1. Koval CE, Poggio ED, Lin Y-C, Kerr H, Eltemamy M, Wee A. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: a report of 10 cases. Am J Transplant 2021; 21:3743–9. - PMC - PubMed
    1. Romagnoli R, Gruttadauria S, Tisone G, et al. Liver transplantation from active COVID-19 donors: a lifesaving opportunity worth grasping? Am J Transplant 2021; 21:3919–25. - PMC - PubMed
    1. Fung M, Babik JM. COVID-19 in immunocompromised hosts: what we know so far. Clin Infect Dis 2020; 72:340–50. - PMC - PubMed