Transplanting kidneys from COVID-19-positive deceased donors appears safe, according to early results from a case series presented at AUA 2022.
At an AUA press conference, Alvin Wee, MD, MBA, program director for kidney transplantation at Glickman Urologic and Kidney Institute at Cleveland Clinic in Ohio, reported results from 55 patients (36 men and 19 women) who received kidneys from 34 COVID-19-positive deceased donors from February to October 2021. Of the 34 donors, 13 (38.2%) had died from COVID-19-related causes and 6 (17.6%) had received extracorporeal membrane oxygenation. Donor selection criteria evolved to the point that only COVID-19-positive donors without significant primary or secondary kidney injury were selected. The average Kidney Donor Profile Index was 36.9.
Among recipients, 67.3% completed standard 2-dose COVID-19 vaccination prior to surgery, whereas 7.3% received 1 dose and 25.5% were not vaccinated. By 4 weeks after transplant surgery, no recipient had tested positive for COVID-19 on PCR, the study found. There was no change in postoperative management, including immunosuppression.
Delayed graft function occurred in 19.6% of the recipients, which the investigators attributed to more donation after cardiac death donors (59%) and longer cold ischemia time. At a mean 3.5 months of follow-up, all grafts were functional. One patient underwent allograft nephrectomy at 1.5 months after transplantation due to Pseudomonas aeruginosa vascular infection. One patient died.
Among the 55 recipients, 32.7% had preemptive transplantation, 47.3% were previously receiving hemodialysis and 20.0% were performing peritoneal dialysis.
“Kidneys from COVID-19 positive donor are safe to transplant. Outcomes are comparable to kidneys from regular donors. We should not walk away from this type of donation,” Dr Wee said in an interview. His team observed no transmission of COVID-19 through transplantation. To date, their institution has completed more than 100 COVID-19-positive kidney transplantation with “excellent” outcomes. Dr Wee and his team will be publishing additional data soon based on longer follow-up and compared with a control group.
Lin Y-C, Kahlil M, Eltemamy M, Kerr H, Krishnamurthi V, Goldfarb D, Wee A. Kidney transplantation with COVID-19 positive donors: A series of 55 cases. Presented at: AUA 2022; May 13-16, 2022. Abstract MP36-01.