Connor Ashton A, Adelman Max W, Mobley Constance M, Moaddab Mozhgon, Erhardt Alexandra J, Hsu David E, Brombosz Elizabeth W, Sanghvi Mansi, Cheah Yee Lee, Simon Caroline J, Hobeika Mark J, Saharia Ashish S, Victor David W, Kodali Sudha, Basra Tamneet, Graviss Edward A, Nguyen Duc T, Elsaiey Ahmed, Moore Linda W, Nigo Masayuki, Drews Ashley L, Grimes Kevin A, Arias Cesar A, Li Xian C, Gaber A Osama, Ghobrial R Mark
Department of Surgery, Houston Methodist Hospital, Houston, TX.
JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX.
Transplant Direct. 2024 Mar 7;10(4):e1590. doi: 10.1097/TXD.0000000000001590. eCollection 2024 Apr.
The COVID-19 pandemic has led to an increase in SARS-CoV-2-test positive potential organ donors. The benefits of life-saving liver transplantation (LT) must be balanced against the potential risk of donor-derived viral transmission. Although emerging evidence suggests that the use of COVID-19-positive donor organs may be safe, granular series thoroughly evaluating safety are still needed. Results of 29 consecutive LTs from COVID-19-positive donors at a single center are presented here.
A retrospective cohort study of LT recipients between April 2020 and December 2022 was conducted. Differences between recipients of COVID-19-positive (n = 29 total; 25 index, 4 redo) and COVID-19-negative (n = 472 total; 454 index, 18 redo) deceased donor liver grafts were compared.
COVID-19-positive donors were significantly younger ( = 0.04) and had lower kidney donor profile indices ( = 0.04) than COVID-19-negative donors. Recipients of COVID-19-positive donor grafts were older ( = 0.04) but otherwise similar to recipients of negative donors. Donor SARS-CoV-2 infection status was not associated with a overall survival of recipients (hazard ratio, 1.11; 95% confidence interval, 0.24-5.04; = 0.89). There were 3 deaths among recipients of liver grafts from COVID-19-positive donors. No death seemed virally mediated because there was no qualitative association with peri-LT antispike antibody titers, post-LT prophylaxis, or SARS-CoV-2 variants.
The utilization of liver grafts from COVID-19-positive donors was not associated with a decreased overall survival of recipients. There was no suggestion of viral transmission from donor to recipient. The results from this large single-center study suggest that COVID-19-positive donors may be used safely to expand the deceased donor pool.
新冠疫情导致新冠病毒检测呈阳性的潜在器官捐献者数量增加。挽救生命的肝移植（LT）的益处必须与供体源性病毒传播的潜在风险相权衡。尽管新出现的证据表明使用新冠病毒阳性供体器官可能是安全的，但仍需要详尽的系列研究来全面评估安全性。本文介绍了在一个中心对29例连续接受来自新冠病毒阳性供体的肝移植患者的研究结果。
对2020年4月至2022年12月期间的肝移植受者进行回顾性队列研究。比较了接受新冠病毒阳性（共29例；25例初次移植，4例再次移植）和新冠病毒阴性（共472例；454例初次移植，18例再次移植）已故供体肝脏移植的受者之间的差异。
新冠病毒阳性供体比新冠病毒阴性供体显著年轻（P = 0.04）且肾脏供体综合指数更低（P = 0.04）。接受新冠病毒阳性供体移植的受者年龄更大（P = 0.04），但在其他方面与接受阴性供体移植的受者相似。供体的新冠病毒感染状态与受者的总体生存率无关（风险比，1.11；95%置信区间，0.24 - 5.04；P = 0.89）。接受来自新冠病毒阳性供体肝脏移植的受者中有3例死亡。似乎没有死亡是由病毒介导的，因为与肝移植围手术期抗刺突抗体滴度、肝移植后预防措施或新冠病毒变异株没有定性关联。
使用来自新冠病毒阳性供体的肝脏移植与受者总体生存率降低无关。没有迹象表明病毒从供体传播到受者。这项大型单中心研究的结果表明，新冠病毒阳性供体可安全用于扩大已故供体库。
