Kidney Transplantation Utilizing SARS-CoV-2 Rt-PCR Positive Donor Kidneys with Immediate Post Exposure Casirivimab /Imdevimab Followed by Thymoglobulin Induction
S. K. Patel1, E. Siskind1, M. Laftavi1, J. Splinter1, E. Shipman2, S. Shah1, S. Nijim1, A. Adekile1, S. Asad1
1Center for Transplantation, University Medical Center of Southern Nevada, Las Vegas, NV, 2Nevada Donor Network, Las Vegas, NV
Meeting: 2022 American Transplant Congress
Abstract number: 545
Keywords: Antilymphocyte antibodies, COVID-19, Kidney transplantation, Reverse transcriptase PCR
Topic: Clinical Science » Infection Disease » 25 - Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Name: Kidney Transplant Infections
Session Type: Rapid Fire Oral Abstract
Date: Tuesday, June 7, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:40pm-5:50pm
Location: Hynes Ballroom B
*Purpose: At the beginning of the pandemic, kidneys from SARS-CoV-2 (COVID) RT-PCR positive donors were not utilized for transplantation, due to the risk of viral transmission. With the advent of the COVID vaccines, and improved monoclonal antibody therapy we transplanted organs from COVID positive donors irrespective of disease severity.
*Methods: We performed six kidney transplants from COVID RT-PCR positive donors. Potential donors were screened for the date of the first positive COVID RT- PCR. Only donors whose test had been positive at least 10 days prior to donation on a nasopharyngeal swab or bronchoalveolar lavage were accepted. A cycle threshold (ct)of ≥ 35 cycles was used as a cut off for accepting kidneys, when results were available prior to donation. Disease severity was not considered in donor evaluation. Recipient selection was performed based on willingness to give informed consent for the use of such kidneys, prior vaccination with at least 2 doses of the COVID vaccine and negative RT-PCRs in the month prior to transplantation.
*Results: We successfully transplanted 6 recipients from 5 donors. While one of the kidneys was recovered locally, the remainder were imported as non mandatory nationally shared organs. Four donors suffered from ARDS secondary to COVID pneumonia. Two donors were on ECMO at the time of donation. Two of the 5 donors were DCD recoveries with warm ischemic times times of 22 and 28 minutes. Co-infections in the donors included Candida glabrata, Enterococcus faecalis, and Burkholderia Cepacia for which appropriate prophylaxis was used in the recipients. All donors had positive nasopharyngeal RT-PCRs. Three had positive bronchioloalveolar lavage RT-PCRs. One donor was RT-PCR negative at the time of donation. Three recipients were sensitized with a PRA of 48%, 96%and 100%. The mean cold ischemic time was 25 hours. The mean KDPI was 51%. The delayed graft function rate was 33%. There was no primary nonfunction, rejection, death or graft loss after median follow-up of 87 (30-250days). The mean recipient GFR was 43ml/min. Dual kidney transplants were performed in two recipients. None of the recipients developed a COVID infection. 5/6 recipients received monoclonal antibodies (casirivimab and imdevimab) immediately after reperfusion. One patient did not receive casirivimab and imdevimab as it was not yet available in our region. All 6 patients received Thymoglobulin induction.
*Conclusions: With careful selection of immunized recipients, clinical assessment of transmission risk, and the preemptive use of monoclonal antibodies post exposure , SARS-Cov-2 positive donor kidneys can be safely utilized for single or dual kidney transplantation, without an increased risk of viral transmission, rejection or graft loss
To cite this abstract in AMA style:Patel SK, Siskind E, Laftavi M, Splinter J, Shipman E, Shah S, Nijim S, Adekile A, Asad S. Kidney Transplantation Utilizing SARS-CoV-2 Rt-PCR Positive Donor Kidneys with Immediate Post Exposure Casirivimab /Imdevimab Followed by Thymoglobulin Induction [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplantation-utilizing-sars-cov-2-rt-pcr-positive-donor-kidneys-with-immediate-post-exposure-casirivimab-imdevimab-followed-by-thymoglobulin-induction/. Accessed March 24, 2023.
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