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Kidneys from Covid patients safe to transplant – US study

A recent study has confirmed that kidneys from organ donors who were diagnosed with Covid-19 are perfectly safe to transplant and do not transmit the virus to recipients of the organs, say researchers at Washington University School of Medicine.

Of the many thousands of kidneys transplanted since the start of the pandemic, there have been no reported infections after surgery related to kidneys donated by people who died and had tested positive for the virus.

Most donors died of causes other than Covid-19, but even in those who had tested positive for the virus within a week of their deaths, there was no effect on the success of the transplants, reports MedicalXPress.

The findings are published in the journal JAMA Network Open.

Initially, the pandemic contributed to a substantial decrease in organ transplants generally, and kidney transplant rates led the way, falling by 50% in the United States during the early months of the pandemic. This was the biggest decline among all solid organs transplanted.

At that time, patients who tested positive for Covid-19 were not eligible to donate any organs, which were discarded out of concern that they could spread the virus to patients receiving transplants.

“However, we have found that kidneys from donors with Covid-19 have a very low chance of transmitting the virus; in fact, we don’t know of a single instance where that has occurred,” said Dr Tarek Alhamad, the medical director of transplant nephrology in the Division of Nephrology.

“These findings suggest that with so many people awaiting transplants, we should not discard kidneys from deceased donors infected with Covid, because both the organs and the people who receive them do well after transplant surgery."

Analysing data collected by the United Network for Organ Sharing (UNOS) transplant registry and involving more than 35 000 kidney donors, Alhamad and his team found that kidneys from people who had tested positive for Covid-19 within a week of donation often were not used.

But as the pandemic wore on, transplant providers were more likely to transplant such organs, and by 2022, organs from donors whose Covid-19 infections had resolved were turned away less frequently.

This year, kidneys are being transplanted from deceased donors who had been diagnosed with active Covid-19 infections within a week of donation.

“We found no higher risk of graft failure or of patient death in those who got kidneys from Covid-positive donors,” said Alhamad, who is also an associate professor of medicine and director of the kidney and pancreas transplant programmes at Barnes-Jewish Hospital.

“Covid-19 was not associated with rejection of the organ, with longer hospitalisation after surgery, or with delays in kidney function after surgery. And two years after transplant, those organs were functioning as well as kidneys from donors who did not have Covid-19.”

During the early days of the pandemic, when many kidneys from Covid-positive donors were discarded, the number of deaths among those on waiting lists for new kidneys rose by 43%. Researchers in France estimated that almost three-quarters of the deaths of those on waiting lists resulted from the pandemic.

According to the American Kidney Fund, there are more than 106 000 people in the US on waiting lists for organ transplants, with 92 000 of them (87%) waiting for a kidney.

Study details

Patterns in Use and Transplant Outcomes Among Adult Recipients of Kidneys From Deceased Donors With Covid-19

Mengmeng Ji, Amanda Vinson, Su-Hsin Chang, Massini Merzkani, Krista Lentine, Yasar Caliskan, Kristin Progar, Nicole Nesselhauf, PharmD5; Casey Dubrawka, Tarek Alhamad.

Published in JAMA Network Open on 30 May 2023

Key Points

Question What are the national patterns in kidney use and transplant outcomes among adult recipients of kidneys from deceased donors with active or resolved Covid-19?

Findings In this cohort study of 35 851 deceased donors and 45 912 adult transplant recipients in the US, the likelihood of non-use of kidneys from active or resolved Covid-19–positive donors decreased over time, with no higher likelihood of non-use for kidneys from Covid-19–positive donors in 2023. Donor Covid-19 positivity was not associated with worse transplant outcomes within 2 years after transplant.

Meaning These findings suggest that the use of kidneys from donors with active or resolved Covid-19 is safe, with excellent outcomes during medium-term follow-up.

Abstract

Importance
While the pandemic enters a new phase and the proportion of individuals with a previous Covid-19 diagnosis increases, the national patterns in kidney use and medium-term kidney transplant (KT) outcomes among patients receiving kidneys from active or resolved Covid-19–positive donors remain unknown.

Objective
To evaluate the patterns in kidney use and KT outcomes among adult recipients of kidneys from deceased donors with active or resolved Covid-19.

Design, Setting, and Participants
This retrospective cohort study was conducted using national US transplant registry data from 35 851 deceased donors (71 334 kidneys) and 45 912 adult patients who received KTs from March 1, 2020, to March 30, 2023.

Exposure
The exposure was donor SARS-CoV-2 nucleic acid amplification test (NAT) results, with positive NAT results within 7 days before procurement defined as active Covid-19 and positive NAT results 1 week (>7 days) before procurement defined as resolved Covid-19.

Main Outcomes and Measures
Primary outcomes were kidney non-use, all-cause kidney graft failure, and all-cause patient death. Secondary outcomes were acute rejection (ie, rejection in the first 6 months after KT), transplant hospitalisation length of stay (LOS), and delayed graft function (DGF). Multivariable logistic regression analyses were performed for kidney non-use, rejection, and DGF; multivariable linear regression analyses were performed for LOS; and multivariable Cox regression analyses were performed for graft failure and all-cause death. All models were adjusted for inverse probability treatment weighting.

Results
Among 35 851 deceased donors, the mean (SD) age was 42.5 (15.3) years; 22 319 (62.3%) were men and 23 992 (66.9%) were white. Among 45 912 recipients, the mean (SD) age was 54.3 (13.2) years; 27 952 (60.9%) were men and 15 349 (33.4%) were black. The likelihood of non-use of kidneys from active or resolved Covid-19–positive donors decreased over time. Overall, kidneys from active Covid-19–positive donors (adjusted odds ratio [AOR], 1.55; 95% CI, 1.38-1.76) and kidneys from resolved Covid-19–positive donors (AOR, 1.31; 95% CI, 1.16-1.48) had a higher likelihood of non-use compared with kidneys from Covid-19–negative donors. From 2020 to 2022, kidneys from active Covid-19–positive donors (2020: AOR, 11.26 [95% CI, 2.29-55.38]; 2021: AOR, 2.09 [95% CI, 1.58-2.79]; 2022: AOR, 1.47 [95% CI, 1.28-1.70]) had a higher likelihood of non-use compared with kidneys from donors without Covid-19. Kidneys from resolved Covid-19–positive donors had a higher likelihood of non-use in 2020 (AOR, 3.87; 95% CI, 1.26-11.90) and 2021 (AOR, 1.94; 95% CI, 1.54-2.45) but not in 2022 (AOR, 1.09; 95% CI, 0.94-1.28). In 2023, kidneys from both active Covid-19–positive donors (AOR, 1.07; 95% CI, 0.75-1.63) and resolved Covid-19–positive donors (AOR, 1.18; 95% CI, 0.80-1.73) were not associated with higher odds of non-use. No higher risk of graft failure or death was found in patients receiving kidneys from active COVID-19–positive donors (graft failure: adjusted hazard ratio [AHR], 1.03 [95% CI, 0.78-1.37]; patient death: AHR, 1.17 [95% CI, 0.84-1.66]) or resolved Covid-19–positive donors (graft failure: AHR, 1.10 [95% CI, 0.88-1.39]; patient death: AHR, 0.95 [95% CI, 0.70-1.28]). Donor Covid-19 positivity was not associated with longer LOS, higher risk of acute rejection, or higher risk of DGF.

Conclusions and Relevance
In this cohort study, the likelihood of non-use of kidneys from Covid-19–positive donors decreased over time, and donor Covid-19 positivity was not associated with worse KT outcomes within two years after transplant. These findings suggest that the use of kidneys from donors with active or resolved Covid-19 is safe in the medium term; further research is needed to assess longer-term transplant outcomes.

 

JAMA Network Open article – Patterns in Use and Transplant Outcomes Among Adult Recipients of Kidneys From Deceased Donors With COVID-19 (Creative Commons Licence)

 

MedicalXPress article – Donated kidneys from deceased COVID-19 patients are safe to transplant, according to study (Open access)

 

See more from MedicalBrief archives:

 

Higher mortality in heart transplants from Covid donors, analysis finds

 

PE doctor who underwent COVID-19-linked lung transplant has died

 

Donor to recipient transmission of SARS‐CoV‐2 by lung transplant

 

 

 

 

 

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