*Purpose: Transplantation of kidneys from donors with active SARS-CoV-2 infection is uncommon due to concerns about the risk of viral transmission and kidney quality. To date, there is no conclusive data that viral transmission from extra-pulmonary solid organ transplant is a possibility. Given the prevalence of SARS-CoV-2 infections in potential donors, the shortage of kidneys available for transplantation and the low risk of viral transmission, we developed a clinical protocol for accepting kidneys from donors with active SARS-CoV-2 infection and preserved kidney function.

*Methods: Retrospective chart review of 5 kidney transplant recipients from 4 deceased donors with severe SARS-CoV-2 infection. Donor and recipient characteristics are reported using descriptive characteristics.

*Results: Donor creatinine ranged from 0.51 to 0.60 mg/dL and KDPI ranged from 14% to 52%. Three of the 5 kidneys came from donation after circulatory death donors. All recipients were fully vaccinated, and 4/5 received post-exposure prophylactic monoclonal antibody treatment. 3 recipients had delayed graft function but were off of dialysis by postoperative day 6 or 8. 3 recipients were readmitted, one for fluid overload and mild rejection on two different occasions, one for hypotension from dehydration and one for sepsis secondary to an aspiration pneumonia. The latter recipient subsequently died with a functioning graft secondary to a severe bacterial infection. This recipient was also found to have a femoral DVT during readmission on the contralateral side to the kidney graft. At 30 days post-transplant, no recipients displayed signs or symptoms of SARS-CoV-2 infection and the three who were readmitted tested negative for SARS-CoV-2 via nasopharyngeal swab. All had a creatinine less than 2 at the most recent follow up.

*Conclusions: Our findings suggest that kidney grafts from donors with severe SARS-CoV-2 infection but preserved kidney function can be safely used and have good early outcomes. However, more research is needed to determine the safety and long term outcomes of kidney transplantation from donors with severe COVID-19 pneumonia.

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