Montiel Villalonga Patricia, Martínez-Alpuente Itzíar, Fernández-Ruiz Mario, Len Óscar, Bodro Marta, Los-Arcos Ibai, Moya José, de la Calle Braulio, Cid-Cumplido Manuela, Sánchez-Etayo Gerard, Ávila Ana, Moreno-González Gabriel, Coll Elisabeth, Domínguez-Gil Beatriz
Organización Nacional de Trasplantes, Madrid, Spain.
Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Department of Medicine, Universidad Complutense, Madrid, Spain.
Transpl Infect Dis. 2023 Feb;25(1):e14008. doi: 10.1111/tid.14008. Epub 2023 Jan 19.
The utilization of non-lung organs from deceased donors with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of donation can be lifesaving, although the safety of this policy must be assessed.
This is a nationwide, prospective study, reporting the experience on the utilization of non-lung organs from SARS-CoV-2-positive donors between December 15, 2020 and May 31, 2022 in Spain.
A total of 69 patients received a solid organ transplant (41 kidney, 18 liver, 8 heart, and 2 combined liver-kidney) obtained from 32 donors with a positive SARS-CoV-2 PCR at the time of donation (four of them with a cycle threshold value <30). All recipients tested negative for SARS-CoV-2 and were free of coronavirus disease 2019 (COVID-19) symptoms prior to transplantation. Nasopharyngeal swab turned positive for SARS-CoV-2 PCR in 4 (5.8%) recipients at 3, 8, 11, and 20 days after transplantation, though evidence did not support a donor-derived COVID-19. Four kidney recipients lost their grafts and two patients died: one heart recipient due to cardiogenic shock and one combined liver-kidney recipient due to lung hypertension and right heart failure. Graft losses and patient deaths were deemed unrelated to the donor SARS-CoV-2 status by the treating teams. No other adverse reactions were reported.
This preliminary experience supports the safety of the use of organs other than lungs from SARS-CoV-2 PCR-positive donors, in alignment with previous series. However, the impact of SARS-CoV-2 infection upon organ quality should be established in future research.
在捐赠时严重急性呼吸综合征冠状病毒2（SARS-CoV-2）聚合酶链反应（PCR）呈阳性的已故捐赠者的非肺器官的利用可能挽救生命，尽管必须评估该政策的安全性。
这是一项全国性的前瞻性研究，报告了2020年12月15日至2022年5月31日期间西班牙对SARS-CoV-2阳性捐赠者的非肺器官利用情况。
共有69名患者接受了实体器官移植（41例肾移植、18例肝移植、8例心脏移植和2例肝肾联合移植），这些器官来自32名捐赠时SARS-CoV-2 PCR呈阳性的捐赠者（其中4名捐赠者的循环阈值<30）。所有受者SARS-CoV-2检测均为阴性，且在移植前无2019冠状病毒病（COVID-19）症状。4名（5.8%）受者在移植后3、8、11和20天鼻咽拭子SARS-CoV-2 PCR检测呈阳性，不过证据不支持感染源自捐赠者的COVID-19。4名肾移植受者移植肾失功，2例患者死亡：1例心脏移植受者死于心源性休克，1例肝肾联合移植受者死于肺动脉高压和右心衰竭。治疗团队认为移植肾失功和患者死亡与捐赠者的SARS-CoV-2状态无关。未报告其他不良反应。
这一初步经验支持使用SARS-CoV-2 PCR阳性捐赠者的非肺器官的安全性，与之前的系列研究结果一致。然而，未来的研究应确定SARS-CoV-2感染对器官质量的影响。
