Comparative Outcomes at a Single Center for 71 Deceased Donor Kidney Transplants from Donors with Sars-CoV-2 RNA Detection

C. E. Koval¹, E. Poggio², M. Eltemamy³, Y. Lin², M. Duck⁴, N. Shrestha⁵, A. Wee²

¹Cleveland Clinic Foundation, Cleveland, OH, ²Cleveland Clinic, Cleveland, OH, ³The Cleveland Clinic, Cleveland, OH, ⁴Nephrology, Cleveland Clinic Foundation, Cleveland, OH, ⁵Infectious Diseases, Cleveland Clinic Foundation, Cleveland, OH

Meeting: 2022 American Transplant Congress

Abstract number: 198

Keywords: COVID-19, Donation, Kidney transplantation

Topic: Clinical Science » Kidney » 32 - Kidney Deceased Donor Selection

Session Information

Session Name: Kidney Deceased Donor Selection I

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 3:30pm-3:40pm

Location: Hynes Ballroom C

*Purpose: Extra-pulmonary organs from donors with SARS-CoV-2 detection during donor evaluation are not accepted by many centers due to theoretical concerns for productive infection and organ injury from COVID-related sequelae. We aimed to compare outcomes for kidney transplantation (KT) from donors with and without SAR-CoV-2 RNA detection, CoVD+ and CoVDneg, respectively.

*Methods: We retrospectively reviewed donor data, recipient data and key outcomes for all adult CoVD+ KTs performed at our center between 2/1/2021 and 10/31/2021 and compared such data to all consecutive adult CoVDneg KTs during the same period. Organ selection was by protocol and excluded donors within the 1^st 14 days of diagnosed symptomatic infection. No COVID-directed therapies were provided to CoVD+ KT recipients (KTRs). Vaccination was not required in early 2021.

*Results: There were 159 KTs, including 71 (44%) from 41 CoVD+’s with mean follow up 151d (range 35-291d). Of the 41 CoV+ donors, 16 (40%) died of COVID complications, mostly hypoxic respiratory failure, with 4 on VV ECMO. For those dying of COVID, the median time from first SARS-CoV2 RNA detection to donation was 28d (range 16-65). Compared to CoVneg donors, CoV+D’s had lower KDPI (mean 31 v 43, mean difference -10.8, 95% CI -18.41 to -3.17, p=0.006), and were more likely DCD (OR 2.41, 95% CI 1.28-0.463, p=0.007). Having a CoV+ donor was not associated with delayed graft function (DGF). On multivariable analysis, CoVD+ was not associated with a higher serum creatinine (Cr) at 1, 3 or 6 months, but DCD was. There was 1 death (from pre-existing interstitial lung disease without SARS-CoV-2 detection from the lower airway) at 4 mo and 1 graft loss at 6 wk post-KT, both in the CoVD+ group. Neither of these KTR’s donors had died of a COVID-related cause. Rejection occurred in 3 CoVD+ and 4 CoVneg KTRs. Six (3.7%) KTRs were diagnosed with COVID, all >3 mo post-KT, with 5/6 occurring >6 mo post-KT during peak periods of circulating virus.

*Conclusions: In a large series, kidney transplant outcomes from CoVD+s were similar to CoVDnegs up to 6 months post-transplant. CoVD+ KT recipients likely benefited from lower KDPI organs. We demonstrate safe and successful transplantation of CoVD+ kidneys outside of the peak period of symptomatic SARS-CoV-2 infection.

Key outcomes for CoV+ compared to CoVneg donors, adjusted for DCD status, gender, and age at KT
Outcome	Number evaluable	Measure	Point estimate	95% CI	p-value
DGF	158	Odds ratio	0.58	0.20-1.57	0.29
Cr, 1 mo	158	Mean difference	0.095	-0.31-0.51	0.63
Cr, 3 mos	123	Mean difference	0.11	-0.43-0.64	0.7
Cr, 6 mos	52	Mean difference	0.68	-0.18-1.54	0.13

To cite this abstract in AMA style:

Koval CE, Poggio E, Eltemamy M, Lin Y, Duck M, Shrestha N, Wee A. Comparative Outcomes at a Single Center for 71 Deceased Donor Kidney Transplants from Donors with Sars-CoV-2 RNA Detection [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/comparative-outcomes-at-a-single-center-for-71-deceased-donor-kidney-transplants-from-donors-with-sars-cov-2-rna-detection/. Accessed November 21, 2024.

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