严重急性呼吸综合征冠状病毒2通过实体器官移植传播的风险及近期移植受者中2019冠状病毒病的结局
Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission Through Solid Organ Transplantation and Outcomes of Coronavirus Disease 2019 Among Recent Transplant Recipients.
作者信息
Free Rebecca J, Annambhotla Pallavi, La Hoz Ricardo M, Danziger-Isakov Lara, Jones Jefferson M, Wang Lijuan, Sankthivel Senthil, Levi Marilyn E, Michaels Marian G, Kuhnert Wendi, Klassen David, Basavaraju Sridhar V, Kracalik Ian T
机构信息
COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
出版信息
Open Forum Infect Dis. 2022 May 2;9(7):ofac221. doi: 10.1093/ofid/ofac221. eCollection 2022 Jul.
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmissible through lung transplantation, and outcomes among infected organ recipients may be severe. Transmission risk to extrapulmonary organ recipients and recent (within 30 days of transplantation) SARS-CoV-2-infected recipient outcomes are unclear.
METHODS
During March 2020-March 2021, potential SARS-CoV-2 transmissions through solid organ transplantation were investigated. Assessments included SARS-CoV-2 testing, medical record review, determination of likely transmission route, and recent recipient outcomes.
RESULTS
During March 2020-March 2021, approximately 42 740 organs were transplanted in the United States. Forty donors, who donated 140 organs to 125 recipients, were investigated. Nine (23%) donors and 25 (20%) recipients were SARS-CoV-2 positive by nucleic acid amplification test (NAAT). Most (22/25 [88%]) SARS-CoV-2-infected recipients had healthcare or community exposures. Nine SARS-CoV-2-infected donors donated 21 organs to 19 recipients. Of these, 3 lung recipients acquired SARS-CoV-2 infections from donors with negative SARS-CoV-2 testing of pretransplant upper respiratory tract specimens but from whom posttransplant lower respiratory tract (LRT) specimens were SARS-CoV-2 positive. Sixteen recipients of extrapulmonary organs from SARS-CoV-2-infected donors had no evidence of posttransplant COVID-19. All-cause mortality within 45 days after transplantation was 6-fold higher among SARS-CoV-2-infected recipients (9/25 [36%]) than those without (6/100 [6%]).
CONCLUSIONS
Transplant-transmission of SARS-CoV-2 is uncommon. Pretransplant NAAT of lung donor LRT specimens may prevent transmission of SARS-CoV-2 through transplantation. Extrapulmonary organs from SARS-CoV-2-infected donors may be safely usable, although further study is needed. Reducing recent recipient exposures to SARS-CoV-2 should remain a focus of prevention.
背景
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可通过肺移植传播，感染器官受者的预后可能很严重。肺外器官受者的传播风险以及近期（移植后30天内）感染SARS-CoV-2的受者预后尚不清楚。
方法
在2020年3月至2021年3月期间，对通过实体器官移植可能发生的SARS-CoV-2传播进行了调查。评估包括SARS-CoV-2检测、病历审查、确定可能的传播途径以及近期受者的预后。
结果
在2020年3月至2021年3月期间，美国进行了约42740例器官移植。对40名捐献者进行了调查，他们向125名受者捐献了140个器官。通过核酸扩增试验（NAAT），9名（23%）捐献者和25名（20%）受者的SARS-CoV-2呈阳性。大多数（22/25 [88%]）感染SARS-CoV-2的受者有医疗保健或社区暴露史。9名感染SARS-CoV-2的捐献者向19名受者捐献了21个器官。其中，3名肺移植受者从移植前上呼吸道标本SARS-CoV-2检测呈阴性但移植后下呼吸道（LRT）标本SARS-CoV-2呈阳性的捐献者那里感染了SARS-CoV-2。16名接受来自感染SARS-CoV-2捐献者的肺外器官移植的受者没有移植后COVID-19的证据。感染SARS-CoV-2的受者移植后45天内的全因死亡率（9/25 [36%]）比未感染的受者（6/100 [6%]）高6倍。
结论
SARS-CoV-2的移植传播并不常见。对肺供体LRT标本进行移植前NAAT可能会预防SARS-CoV-2通过移植传播。来自感染SARS-CoV-2捐献者的肺外器官可能可以安全使用，不过仍需进一步研究。减少近期受者接触SARS-CoV-2应仍然是预防的重点。
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