Implications of Pre-Transplant (tx) COVID-19 on SOT or HCT: A Multicenter Study

G. Haidar¹, K. Hughes-Kramer², C. Alonso³, J. Hand⁴, E. Blodget⁵, V. Srinivasa⁵, S. Aslam⁶, H. Hassouna⁷, C. Lawson⁷, M. Malinis⁸, S. Anjan⁹, E. Lease¹⁰, M. Al-Obaidi¹¹, P. Vergidis¹², J. Husson¹³, D. van Duin¹⁴, R. Avery¹⁵, K. Downes¹⁶, M. R. Heldman¹⁰, J. Nelson¹⁷, S. Pouch¹⁸, S. Chuang¹⁹, C. Kao²⁰, M. Estabrook²¹, F. Alconchel²², S. Mazumber²³, P. Samanta², M. Wagener², N. Singh², F. Silveira²

¹UPitt, Pitt, PA, ²UPitt, Pittsburgh, PA, ³BIDMC, Boston, MA, ⁴Ochsner, New Orleans, LA, ⁵USC, Los Angeles, CA, ⁶UCSD, San Diego, CA, ⁷Spectrum Health, Grand Rapids, MI, ⁸Yale, New Haven, CT, ⁹UMiami, Miami, FL, ¹⁰UW, Seattle, WA, ¹¹U Arizona, Tucson, AZ, ¹²Mayo, Rochester, MN, ¹³UMMC, Baltimore, MD, ¹⁴UNC, Chapel Hill, NC, ¹⁵JHU, Baltimore, MD, ¹⁶CHOP, Philadelphia, PA, ¹⁷Stanford, Stanford, CA, ¹⁸Emory, Decatur, GA, ¹⁹U Rochester, Rochester, NY, ²⁰WashU, St Louis, MO, ²¹WashU, Saint Louis, MO, ²²Spain, Murcia, Spain, ²³U Tennessee, Memphis, TN

Meeting: 2022 American Transplant Congress

Abstract number: 1622

Keywords: COVID-19, Outcome, Waiting lists

Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)

Session Information

Session Name: All Infections (Excluding Kidney & Viral Hepatitis) IV

Session Type: Poster Abstract

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Describe outcomes of patients (pt) with pre-tx COVID-19.

*Methods: Multicenter study of SOT/HCT candidates who had a positive (pos) SARS-CoV-2 PCR pre-tx.

*Results: Pre-tx: Of 208 pt, median age was 56 (range 3-76). 87.8% were SOT candidates (40.5% kidney, 40.5% liver, 9.8% lung, 6.9% heart, 2.3% pancreas) and 13.9% were HCT candidates (54.2% allo, 45.8% auto). Pt underwent a median of 2 tests (range 1 – 14). In 41% of pt, > 1 neg PCR was required by the tx center before reactivation. Neg PCR was documented in 67.4% of pt at a median of 41 days (18-68) after pos PCR. Waitlist mortality was 11.0%; deaths were due to COVID-19 in 60% (12/20).

Post-tx (all pt): 78 pt underwent tx at a median of 65.5 days (range 17-324) from COVID-19; 71/78 have completed 4-weeks of follow-up. 24/78 (30.7%) pt were still PCR pos at time of tx (details below). 54/78 (69.2%) pt underwent routine PCR testing post-tx; 62% were tested regularly for 8 weeks. Only 1 pt, who remained asymptomatic, developed recurrent pos PCR on surveillance testing 18 days post-tx. 1 pt had graft loss. There were no deaths at 4 weeks post-tx.

Pt transplanted without a negative PCR: 24 pt with COVID-19 did not have neg PCR at time of tx: 9 (37.5%) kidney, 9 (37.5%) liver, 2 (8.3%) SLK, 1 (4.2%) lung, 1 heart (4.2%), 2 auto-HSCT (8.3%), 2 allo-HSCT (8.3%). Of 24 pt who were reactivated at a median of 21 days (range 8 – 38) from COVID-19 diagnosis, 7 underwent tx emergently (5 liver, 1 lung, 1 heart). 20/24 completed 4-weeks of follow-up; all were alive. PCR Cycle thresholds (Ct) increased over time, suggesting a reduction in SARS-CoV-2 viral loads with time elapsed since COVID-19 diagnosis.

*Conclusions: Short-term outcomes of transplantation in SOT/HCT candidates with prior COVID-19 were promising in this small cohort, even with a positive PCR going into transplant. Whether documentation of a negative PCR should be required for all tx candidates with a history of COVID-19 prior to transplantation should be investigated further, particularly among lung tx candidates. For certain tx candidates with COVID-19, relying time-based strategy instead of a test-based strategy may be safe.

To cite this abstract in AMA style:

Haidar G, Hughes-Kramer K, Alonso C, Hand J, Blodget E, Srinivasa V, Aslam S, Hassouna H, Lawson C, Malinis M, Anjan S, Lease E, Al-Obaidi M, Vergidis P, Husson J, Duin Dvan, Avery R, Downes K, Heldman MR, Nelson J, Pouch S, Chuang S, Kao C, Estabrook M, Alconchel F, Mazumber S, Samanta P, Wagener M, Singh N, Silveira F. Implications of Pre-Transplant (tx) COVID-19 on SOT or HCT: A Multicenter Study [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/implications-of-pre-transplant-tx-covid-19-on-sot-or-hct-a-multicenter-study/. Accessed May 18, 2025.

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