A donor kidney from a patient who died of COVID-19 has been successfully and safely transplanted into a grateful recipient who, at 90 days, has shown excellent renal recovery and no signs of the virus, new research indicates.
The case report was published online January 13 in the American Journal of Transplantation.
While this is not the first patient to receive a kidney from a deceased donor infected with the coronavirus, it is the first procedure to subject tissue samples from the donor to highly sophisticated molecular tools to make sure there was no evidence of the virus harboring within. There are currently no standardized tissue-based testing platforms or validated protocols to follow; rather, transplant recipients are checked for evidence of the coronavirus after the fact using a standard nasal swab test.
“Some of this was a leap of faith, based on experience throughout the years with donors who had other viral infections such as hepatitis C,” Niraj Desai, MD, surgical director, kidney and pancreas transplant program, Johns Hopkins Medicine, Baltimore, Maryland, acknowledged in a statement.
“Although this case wasn’t exactly like those others, we had some measure of confidence in a safe outcome,” he added.
Colleague Hamid Rabb, MD, medical director, Johns Hopkins kidney transplant program, concurred, adding in the same statement that they are aware their particular case may not be representative of other possible COVID-19 donors, particularly because this individual donor tested negative for COVID-19 at the time of transplantation.
“However, it’s a step forward using highly sensitive molecular testing to show it can be safe to use organs from deceased COVID-19 donors [and] organs can be individually considered for kidney transplant instead of being routinely discarded,” he suggested.
Concerns have been voiced about using kidneys from donors who died from COVID-19 because the kidneys could be infected with the virus based on autopsy findings and high levels of viral receptors in the kidneys themselves.
The donor was a 30-year-old woman who was admitted to hospital with severe COVID-19 pneumonia. “With clinical worsening, she was placed on extracorporeal membrane oxygenation, but developed hypoxic brain injury and progressed to brain death,” said lead author Kyungho Lee, MD, John Hopkins University School of Medicine.
In situ hybridization and quantitative RT-PCR tests were used on pre-implantation biopsy samples from the donor kidney to determine whether SARS-CoV-2 RNA was present. “We found no evidence of SARS-CoV-2 in donor tissues,” Lee notes. The recipient tested negative for the virus at days 20, 30, and 90 following transplantation and showed no signs or symptoms of COVID-19, investigators add.
The authors emphasize there isn’t much evidence to support the use of organs from deceased donors who died from COVID-19, and as such, the decision to accept nonlung organs from these donors must be decided on a case-by-case basis.
On the other hand, “based on recent observations of successful KT [kidney transplant] outcomes from mild or asymptomatic SARS-CoV-2 positive donors, and a short-term safety report of KT from a donor similar to this case, the transmission risk of SARS-CoV-2 through KT is likely very low,” the authors state. However, they add that larger studies are needed to confirm their findings as well as monitor long-term graft outcomes in patients who receive kidneys from COVID-19 donors.
The authors have reported no relevant financial relationships.
Am J Transplant. Published online January 31, 2022. Full text