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Abstract: SA-OR41

Utilization of SARS-CoV-2 (COVID-19)-Positive Donor Kidneys

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Mckinney, Warren T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Schladt, David P., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Israni, Ajay K., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

The Organ Procurement and Transplantation Network requires documentation of SARS-CoV-2 (COVID) testing status for each potential donor and lower respiratory specimen testing with nucleic acid tests for all donor lungs. In the absence of guidelines for the use of COVID–positive donor kidneys, we sought to examine the clinical characteristics of COVID–positive donors and trends in the utilization of COVID–positive donor kidneys.

Methods

This study used Scientific Registry of Transplant Recipients data and included all deceased donors (n=24,940) and recipients (n= 29,478) from June 1, 2020, through April 2, 2022. Variation in donor and recipient characteristics were considered significant at P<.05.

Results

1,310 (5.35%) of donors during the observation period had a positive test for COVID-19 with 1,731 (67.70%) kidneys transplanted, 108 (4.22%) not recovered, and 714 (27.92%) recovered but not transplanted. COVID-positive donors differed from COVID–negative or untested donors in terms of race, ethnicity, cause of death, and donation after circulatory death status (all P < .05). 813 recipients (2.76%) received COVID-positive deceased donor kidneys. Recipients of COVID–positive donor kidneys were more likely to be White, not have received a previous transplant, and had greater cold ischemic times (all P < .05). The number of transplants with COVID–positive donors peaked in early 2022 (Figure 1). Adjusted hazard ratios for all-cause graft failure with COVID-positive donors and death were 0.89 (95% CI, 0.62-1.28) and 0.87 (95% CI, 0.52-1.46), respectively.

Conclusion

Transplant with COVID-positive donor kidneys increased during the study period and is not associated with increased risks for recipients. However, high discard rates for COVID–positive donors and greater cold ischemic times may suggest that such donor kidneys remain difficult to place. Patient- and transplant program–level interventions targeting decision support and risk aversion may be necessary to reduce discard rates for COVID–positive donor kidneys.

COVID Positive Transplants by Week

Funding

  • Other NIH Support