Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Am J Transplant. 2022 Dec;22(12):2903-2911. doi: 10.1111/ajt.17203. Epub 2022 Oct 17.
Emerging data support the safety of transplantation of extra-pulmonary organs from donors with SARS-CoV-2-detection. Our center offered kidney transplantation (KT) from deceased donors (DD) with SARS-CoV-2 with and without COVID-19 as a cause of death (CoV + COD and CoV+) to consenting candidates. No pre-emptive antiviral therapies were given. We retrospectively compared outcomes to contemporaneous DDKTs with negative SARS-CoV-2 testing (CoVneg). From February 1, 2021 to January 31, 2022, there were 220 adult KTs, including 115 (52%) from 35 CoV+ and 33 CoV + COD donors. Compared to CoVneg and CoV+, CoV + COD were more often DCD (100% vs. 40% and 46%, p < .01) with longer cold ischemia times (25.2 h vs. 22.9 h and 22.2 h, p = .02). At median follow-up of 5.7 months, recipients of CoV+, CoV + COD and CoVneg kidneys had similar rates of delayed graft function (10.3%, 21.8% and 21.9%, p = .16), rejection (5.1%, 0% and 8.5%, p = .07), graft failure (1.7%, 0% and 0%, p = .35), mortality (0.9%, 0% and 3.7%; p = .29), and COVID-19 diagnoses (13.6%, 7.1%, and 15.2%, p = .33). Though follow-up was shorter, CoV + COD was associated with lower but acceptable eGFR on multivariable analysis. KT from DDs at various stages of SARS-CoV-2 infection appears safe and successful. Extended follow-up is required to assess the impact of CoV + COD donors on longer term graft function.
新兴数据支持从检测到 SARS-CoV-2 的供体中移植肺外器官的安全性。我们中心为同意的候选人提供了来自 SARS-CoV-2 供体的肾移植（KT），无论供体是否有 COVID-19 作为死亡原因（CoV + COD 和 CoV + ）。没有进行抢先的抗病毒治疗。我们回顾性地将结果与同期接受 SARS-CoV-2 检测阴性（CoVneg）的 DDKT 进行了比较。从 2021 年 2 月 1 日至 2022 年 1 月 31 日，共有 220 例成人 KT，其中 35 例 CoV + 中有 115 例（52%），35 例 CoV + COD 中有 33 例。与 CoVneg 和 CoV + 相比，CoV + COD 更常为 DCD（100%对 40%和 46%，p < 0.01），冷缺血时间更长（25.2 小时对 22.9 小时和 22.2 小时，p = 0.02）。在中位随访 5.7 个月时，CoV + 、CoV + COD 和 CoVneg 供体肾的延迟移植物功能障碍发生率相似（10.3%、21.8%和 21.9%，p = 0.16），排斥反应（5.1%、0%和 8.5%，p = 0.07），移植物衰竭（1.7%、0%和 0%，p = 0.35），死亡率（0.9%、0%和 3.7%，p = 0.29）和 COVID-19 诊断（13.6%、7.1%和 15.2%，p = 0.33）。尽管随访时间较短，但多变量分析显示 CoV + COD 与可接受的较低 eGFR 相关。来自 SARS-CoV-2 感染各个阶段的 DD 的 KT 似乎是安全且成功的。需要进行更长时间的随访，以评估 CoV + COD 供体对长期移植物功能的影响。
