Use of kidneys from COVID-19-positive deceased donors is gradually increasing in the United States with favorable short-term graft outcomes, a new study finds.
Tarek Alhamad, MD, MS, of Washington University School of Medicine in St Louis, Missouri, and colleagues studied national trends using 2020-2023 US transplant registry data from 35,851 deceased donors (71,334 kidneys) and 45,912 adult recipients. Active COVID-19 was defined as a positive donor SARS-CoV-2 nucleic acid amplification test (NAT) result within 7 days of procurement and resolved COVID-19 as any COVID-19 positive test more than 7 days before procurement.
The risks for graft failure and death within 2 years of transplantation were no higher for recipients of kidneys from deceased donors with active or resolved COVID-19 than for recipients of kidneys without COVID-19 infection, the investigators reported in JAMA Network Open. Donor COVID-19 positivity also was not significantly associated with greater risk of delayed graft function, acute rejection, or longer hospital stay.
Nonuse of kidneys from COVID-19-positive donors decreased over time, the team reported. Overall, the likelihood of kidney nonuse was 1.6- and 1.3-fold higher for active and resolved COVID-19-positive donors than for negative donors. For active COVID-19 donor kidneys, the odds of nonuse significantly decreased from 11.3-fold in 2020 to 2.1-fold in 2021 to 1.5-fold in 2022. For resolved COVID-19 donor kidneys, the odds of nonuse significantly decreased from 3.9-fold in 2020 to 1.9-fold in 2021. By 2023, use of kidneys from active and resolved COVID-19 donors was similar to that of negative donors, the investigators reported.
“Our findings offer robust evidence suggesting that the use of kidneys from COVID-19–positive donors is safe during medium-term follow-up; however, longer-term follow-up is necessary to further validate this practice,” according to Dr Alhamad’s team.
Ji M, Vinson AJ, Chang SH, et al. Patterns in use and transplant outcomes among adult recipients of kidneys from deceased donors with COVID-19. JAMA Network Open. Published online May 30, 2023. doi:10.1001/jamanetworkopen.2023.15908