Risk of SARS-CoV-2 transmission through solid organ transplantation and outcomes of COVID-19 among recent transplant recipients

Abstract Introduction SARS-CoV-2 is transmissible through lung transplantation, and outcomes among SARS-CoV-2-infected solid organ transplant (SOT) recipients may be severe; however, 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 SOT reported to the Organ Procurement and Transplantation Network were investigated. Laboratory and epidemiologic assessments included SARS-CoV-2 testing, medical record review, determination of likely transmission route, and recent SOT recipient outcomes. Results During March 2020-March 2021, ∼42,740 organs including ∼2,736 lungs were transplanted in the United States. Forty donors (37 deceased), 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 testing (NAAT). Most (22/25, 88%) SARS-CoV-2-infected recipients had exposures in healthcare or community settings. Nine SARS-CoV-2-infected donors donated 21 organs (including three bilateral lungs) to 19 recipients. Of these, three lung recipients acquired SARS-CoV-2 infections from donors who were SARS-CoV-2-negative based on testing of pretransplant upper respiratory tract specimens but from whom posttransplant lower respiratory tract (LRT) specimens tested positive for SARS-CoV-2; one recipient died. 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 six-fold higher among SARS-CoV-2-infected recipients (9/25, 36%) than without (6/100, 6%). Conclusion SARS-CoV-2 transmission through SOT is uncommon. Pretransplant NAAT of lung donor LRT specimens may prevent transmission of SARS-CoV-2 via lung transplantation. Extrapulmonary organs from SARS-CoV-2-infected donors may be safely usable, although further study is needed. Given the high mortality, reducing recent recipient exposures to SARS-CoV-2 should remain a focus of prevention.