Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Anaesth Crit Care Pain Med. 2022 Aug;41(4):101098. doi: 10.1016/j.accpm.2022.101098. Epub 2022 May 6.
Solid-organ transplantation (SOT) from SARS-CoV-2 positive donors could be a life-saving opportunity worth grasping. We perform a systematic review to evaluate the recipient outcomes of SOT from donors with recent or current SARS-CoV-2 infection.
Search strategy was performed in PubMed, Cochrane COVID-19 Study Register, and Web of Science databases from the 1 of January 2019 to the 31 of December 2021. SOT adult recipients from a donor with past or current SARS-CoV-2 infection were elegible for inclusion. Outcomes were viral transmission, COVID-19 symptoms, mortality, hospital stay, and complications. PROSPERO Register Number: CRD42022303242 FINDINGS: Sixty-nine recipients received 48 kidneys, 18 livers and 3 hearts from 57 donors. Six additional transplants from positive lungs were identified. IgG+ anti-SARS-CoV-2 titers were detected among 10/16 recipients; only 4% (3/69) recipients were vaccinated. Non-lung transplant recipients received organs from 10/57 (17.5%) donors with persistent COVID-19. In 18/57 donors, SARS-CoV-2 RNA was detected (median 32 Cycle threshold [Ct]) at procurement. Among non-lung transplant recipients, SARS-CoV-2 viral transmission was not documented. Four patients presented delayed graft dysfunction, two patients acute rejection, and two patients died of septic shock. The median (IQR) hospital stay was 18 (11-28) days in recipients from symptomatic donors. Viral transmission occurred from three lung donors to their recipients, who developed COVID-19 symptoms. One of the recipients subsequently died.
Use of non-lung (kidney, liver and heart) organs from SARS-CoV-2 positive donors seem to be a safe practice, with a low risk of transmission irrespective of the presence of symptoms at the time of procurement. Low viral replication (Ct > 30) was safe among non-lung donors, even if persistently symptomatic at procurement.
从 SARS-CoV-2 阳性供体进行实体器官移植（SOT）可能是一个值得抓住的救命机会。我们进行了一项系统评价，以评估近期或当前 SARS-CoV-2 感染供体的 SOT 受者的结局。
从 2019 年 1 月 1 日至 2021 年 12 月 31 日，在 PubMed、Cochrane COVID-19 研究注册中心和 Web of Science 数据库中进行了搜索策略。从过去或当前 SARS-CoV-2 感染的供体中接受 SOT 的成年受者符合纳入标准。结局为病毒传播、COVID-19 症状、死亡率、住院时间和并发症。PROSPERO 注册号：CRD42022303242。
69 名受者接受了来自 57 名供者的 48 个肾脏、18 个肝脏和 3 个心脏的移植，另外还发现了 6 例阳性肺移植。在 10/16 名受者中检测到 IgG+抗-SARS-CoV-2 滴度；只有 4%（3/69）的受者接受了疫苗接种。非肺移植受者接受了来自 10/57（17.5%）持续性 COVID-19 供者的器官。在 18/57 名供者中，在采集时检测到 SARS-CoV-2 RNA（中位数 32 循环阈值 [Ct]）。在非肺移植受者中，未记录到 SARS-CoV-2 病毒传播。4 名患者出现迟发性移植物功能障碍，2 名患者出现急性排斥反应，2 名患者死于感染性休克。来自有症状供者的受者的中位（IQR）住院时间为 18（11-28）天。来自 3 名肺供者的病毒传播给他们的受者，受者出现 COVID-19 症状。其中 1 名受者随后死亡。
使用 SARS-CoV-2 阳性供体的非肺（肾脏、肝脏和心脏）器官似乎是一种安全的做法，无论在采集时是否有症状，传播风险都很低。即使在采集时持续有症状，低病毒复制（Ct>30）在非肺供者中也是安全的。
