Utilization of SARS-CoV-2-Positive donors in pediatric renal transplantation

As COVID-19-positive donors are becoming more common, there is an increasing need for the transplant community to evaluate the safety and efficacy of organ transplant from a SARS-CoV-2-infected donor.

Here we describe outcomes of two pediatric kidney transplant recipients who were vaccinated against COVID-19 and received their allograft from a SARS-CoV-2-positive donor.

Both donors did not die from a COVID-19-related illness; the first donor had 1 week of COVID-19 symptoms 4 weeks prior to donation and the second was asymptomatic. Donor 1 had a Ct of 33.4 at 3 days and Donor 2 with a Ct of 37.2 at 16 days prior to donation. The first recipient was positive for SARS-CoV-2 anti-spike IgG on the day of transplant, but the second patient was negative and both patients received IVIg perioperatively. There was no evidence of SARS-CoV-2 transmission or compromised renal function at 86- and 80-day post-transplant, respectively.

This case series suggests favorable short-term outcomes with accepting SARS-CoV-2-positive donors for pediatric renal transplantation, after thorough evaluation of the donor's risk for transmission, assessing the recipient's serologic status to SARS-CoV-2, and considering pre-emptive measures to mitigate the risk for severe COVID-19 should the recipient acquire donor-derived SARS-CoV-2.