Using kidneys from donors with COVID-19 is safe: JAMA

A recent study published in JAMA has explained that using kidneys from COVID-19 donors, active or resolved, is safe. Researchers have reported excellent outcomes during the follow-up period.

The COVID-19 pandemic has raised many health-related questions. One such critical question is using Kidney donated from active or resolved COVID-19. The pandemic has led to a decrease in solid organ transplant rates globally.

 

Kidney transplants are the most affected among organ transplants, followed by lung, liver, and heart transplants.

 

In the beginning, COVID-19–positive patients were not eligible to be donors so it greatly reduced transplant volume. According to the National Institute of Health, the kidney is the most commonly transplanted organ. The COVID-19 pandemic required Kidney Transplant professionals to make difficult decisions regarding the use of kidneys from donors with SARS-CoV-2 infection. The potential risks of infectivity had to be weighed against the discard of valuable organs. Since there has been an increase in the proportion of individuals with a previous COVID-19 diagnosis, the impact of previous COVID-19 diagnoses on potential kidney donors requires further consideration. Researchers obtained data from August 8, 2020, to September 29, 2021. They assessed only 150 SARS-CoV-2 NAT–positive donors for organ donation. Out of the 295 kidneys procured from NAT-positive donors, 34.6% were not used, in comparison to the nonuse rate of 20.6 % for kidneys from NAT-negative donors. Kidney nonuse means “kidney recovered for transplant but not transplanted.” The primary reason cited for this high nonuse rate was related to the lack of available recipients. But, However, the decision-making process was also affected by the risk of COVID-19 transmission and the overall balance of risks and benefits associated with using those organs.

 

Considering this background and get clarity of these important ongoing questions, Mengmeng Ji, Ph.D., MBBS from the Division of Nephrology, Washington University in St Louis, St Louis, Missouri with a team of colleagues did a study to explore the patterns in nonuse of kidneys from deceased donors with active or previous COVID-19 and KT outcomes among adult recipients. The researchers used the Organ Procurement and Transplantation Network (OPTN) database which has data related to transplant waiting list candidates, recipients, and donors in the US, including demographic and clinical characteristics details at the time of waiting list entry and transplant. The key results of this study are:

 

·   71 334 kidneys were recovered from 35 851 deceased donors (mean age 42 years, 62% men and 37 % women) with COVID-19 test results from March 1, 2020, to March 30, 2023.

·   Of 66 831 recovered kidneys from COVID-19–negative donors, 24.2% were unused and 75.8% were transplanted.

·   Of 2165 recovered kidneys from active COVID-19–positive donors,29.2% were not used 70.8% were transplanted.

·   Of 2338 recovered kidneys from resolved COVID-19–positive donors, 26.3% were unused, and 73.7% were transplanted.

·   Researchers found that among adult KT recipients, kidneys from resolved or active COVID-19 donors did not increase the risk of graft loss, death, acute rejection, DGF, or longer hospitalization compared with kidneys from COVID-19–negative donors.

·   kidneys from COVID-19–positive donors is safe.

 

This is very useful information for Kidney Transplant professionals, nephrologists, and patients.

When the COVID-19 pandemic started, the number of organs being transplanted decreased dramatically. The global transplant rates went down by 15%.

The partial reason related to this was redistribution and redeployment of staff, lack of hospital beds, etc. But the other reason was about the risk and safety of proceeding with kidney transplants during such a time.

 

There was no data confirming the risks and benefits of using kidneys from donors who had COVID-19. This study found that there were more cases where kidneys from COVID-19-positive donors were not used.

 

The study has provided crucial insight. It is important to note that maximizing the use of all potentially transplantable organs is a life-saving priority.

Proceeding with solid organs transplant obtained from living and deceased donors after confirmed COVID-19 resolution is safe. Considering Kidney Transplants, success is being reported.

For kidneys procured in 2023, donor COVID-19 positivity is not associated with a higher risk of nonuse.

 

COVID-19 pandemic progress has accounted for numerous changes including enhanced institutional operations and resource allocation, newer therapeutic options, vaccine development and distribution, and recommendations regarding clinical practice and management within the solid organ transplant community.

National guidelines from the American Society of Transplantation were last updated in January 2023. These guidelines state that donors who are SARS-CoV-2 NAT-positive and died of COVID-19 complications should be considered for “nonlung transplant acceptance.

 

In this study, researchers have said that “We support the use of these valuable organs and encourage organ procurement organizations to consider recovering more kidneys from COVID-19–positive donors and promote further acceptance among transplant professionals.”