Utilization and Discard of Organs from Covid -19 Infected Donors: A Us National Registry Analysis
1Virginia Commonwealth University, Richmond, VA, 2University of Arizona, Tuscon, AZ, 3University of Utah, Salt Lake City, UT
Meeting: 2022 American Transplant Congress
Abstract number: 158
Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)
Session Information
Session Name: COVID-19 Infections Part 1: All Organs
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 5, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-5:40pm
Location: Hynes Ballroom B
*Purpose: Expansion of the donor pool remains a major unmet need for solid organ transplants (SOT). Early data suggests that at least some severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID) nucleic acid test positive (NAT+) organs could be transplanted safely although there is substantial controversy about this topic.
*Methods: A retrospective analysis of the national United States Organ Procurement and Transplantation Network database was performed, demonstrating initial experience with COVID NAT+ deceased donor organs with a focus on kidney transplants, from August 8, 2020, to Sep 29, 2021.
*Results: During this time period, 17,143 COVID NAT negative (NAT-) deceased donors and 150 COVID NAT+ deceased donors were assessed for organ donation (Figure 1) (Table 1). When compared to COVID NAT- donors, there was a higher (p<0.001 for all) non-recovery rate for COVID NAT+ hearts (35% vs 87%), lungs (71% vs 99%), livers (24% vs 53%), and pancreas (89% vs 98 %). Of a total of 385 recovered organs from 150 COVID NAT+ donors, 276 (72%) organs were transplanted into 262 recipients. Majority of donors had a COVID NAT+ ≤7 days prior to procurement (94; 62.7%). While only a minority of pancreases, hearts, lungs, and livers were procured, almost all were transplanted post-procurement. In contrast, there was a high discard rate for kidneys post-procurement (102/295; 34.6%) with the most common reason (~70%) for discards being ‘exhaustion of the wait list’. Presumably superior quality COVID NAT+ kidneys were discarded compared with COVID NAT- kidneys (mean KDPI: 67% vs 76%; p=0.04). Limited outcome data was available with a median post-transplant follow-up of 75 days (range: 23-243 days). Three kidney allograft losses (2 due to allograft thrombosis) and five deaths (2 kidneys, 3 livers) were reported, of which, one was due to respiratory failure and one due to sepsis.
*Conclusions: These data provide early reassuring evidence on the utilization of non-lung COVID NAT+ organs. However, a substantially lower procurement rate for non-kidney transplantable organs and a high discard rate for kidneys were noted.
| Positive COVID NAT Result- n (%) | 150 (100) |
| COVID NAT test site- n (%) Lower respiratory Upper respiratory Rectal |
13 (8) 136 (91) 1 (1) |
| Age (years) – mean (SD) Sex (male) – n (%) BMI (kg/m2)-mean (SD) Caucasian Race- n (%) Kidney Donor Profile Index – mean (SD, %) Terminal Creatinine (mg/dl)-median (IQR) |
43 (14) 98 (65) 32 (9.5) 91 (61) 48 (27) 0.89 (0.53, 1.5) |
| Pulmonary Infection-n (%) Chest X-ray-n(%) Normal Abnormalleft Abnormal right Abnormal both |
74 (49) 13 (10) 9 (7) 9 (7) 96 (76) |
| Cause of death -n (%) Anoxia Stroke Other |
48 (32) 33 (22) 69 (46) |
| Right kidney reason for discard, n (%) Donor’s medical history Biopsy finding Poor organ function No recipient located list exhausted Unknown |
1 (2.5) 3 (7.5) 2 (5) 27 (67.5) 7 (17.5) |
| Left kidney reason for discard, n (%) Biopsy finding Poor organ function No recipient locatedlist exhausted Unknown |
3 (8) 1 (3) 27 (73) 6 (16) |
| Double kidneys reason for discard, n (%) No recipient located list exhausted Unknown |
4 (80) 1 (20) |
To cite this abstract in AMA style:
Azhar A, Moinuddin I, Gungor AB, Morales MK, Molnar MZ, Tanriover B, Gupta G. Utilization and Discard of Organs from Covid -19 Infected Donors: A Us National Registry Analysis [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/utilization-and-discard-of-organs-from-covid-19-infected-donors-a-us-national-registry-analysis/. Accessed January 18, 2025.« Back to 2022 American Transplant Congress