During the COVID-19 pandemic, transplantation of COVID-19 infected deceased donor kidneys gradually increased from 2020 to 2021 in the United States, before spiking in the first quarter of 2022, investigators revealed at Kidney Week 2022, the annual meeting of the American Society of Nephrology, in Orlando, Florida. Recipients of COVID-19 positive donor kidneys had no worse graft outcomes than other recipients.
According to the June 2020 to April 2022 Scientific Registry of Transplant Recipients, 1310 of 24,940 total deceased donors (5.35%) had COVID-19. Among 29,478 recipients, 813 (2.76%) received at least 1 COVID-19 positive deceased donor kidney.
A total of 1731 (67.7%) COVID-19 positive kidneys were transplanted, 714 (27.9%) were recovered but not transplanted, and 108 (4.2%) were not recovered at all, Warren McKinney, PhD, of Hennepin Healthcare Research Institute, University of Minnesota in Minneapolis reported on behalf of his team. Yet the risks for all-cause graft failure and death did not differ significantly between recipients of COVID-19 positive vs negative donor kidneys, he stated. Cold ischemia times were longer for COVID-19 positive kidneys, however. The team did not examine rates of delayed graft function.
He told Renal & Urology News that “high discard rates for COVID-positive donors and greater cold ischemic times may suggest that such donor kidneys remain difficult to place. Patient- and transplant program-level interventions targeting decision support and risk aversion may be necessary to reduce discard rates for COVID-positive donor kidneys.”
Co-investigator Ajay Israni, MD, MS, added: “Nephrologists should assure transplant candidates that a COVID-19 positive donor kidney can be acceptable. Patients should learn about the transplant center’s criteria for accepting COVID-19 positive donor kidneys at the time of listing, so that they’re not processing this information for the first time at kidney offering, when a rapid response is needed.”
Recipients of COVID-positive deceased donor kidneys were significantly more likely to be White patients undergoing their first kidney transplantation. Race and ethnic profile, cause of death, and donation after circulatory death status differed significantly between COVID-19 positive and negative (or untested) donors.
Mckinney WT, Schladt DP, Israni AK. Utilization of SARS-CoV-2 (COVID-19)-positive donor kidneys. Presented at: Kidney Week 2022; November 3-6, Orlando, Florida. Abstract SA-OR41.