Comparative 3-Year Allograft Outcomes for Recipients of Kidneys From SARS-CoV-2 NAT-Positive Donors

Data demonstrates safety and short-term success of kidney transplantation (KT) from SARS-CoV-2 NAT-positive organ donors (NAT+) compared to NAT-negative donors. However, detailed reports of longer-term graft outcomes are limited and lack granular data on donor SARS-CoV-2 infection severity.

We retrospectively reviewed records from 220 recipients of KT (KTRs) at our institution from February 1, 2021, to January 31, 2022. We compared 1- and 3-year allograft-specific outcomes for KTRs from NAT+ (N = 59), CoV-COD (COVID as cause of death) (N = 56), and NAT-neg (N = 105) donors. We reviewed and compared pathology findings for allograft biopsies for all groups up to 1 year. We examined the association of eGFR at 3 years with CoV-donor status using multivariable linear regression.

At 1 year, there was no difference in rejection or kidney pathologies by CoV-donor status. At 3 years, there was no difference in patient death or graft loss by group. For subjects without graft loss, eGFR at 3 years for NAT+, CoV-COD, and NAT-neg donors was 54.8 (21.8), 45.6(17.9), and 48.4 (23.3) mL/min/m², respectively (p = 0.61). On multivariable analysis, there was no significant association of eGFR with CoV-donor status.

We found no significant difference in pathological findings or 3-year allograft outcomes following KT from NAT-negative, NAT+, or CoV-COD donors. Despite modestly reduced eGFR for COV-COD on unadjusted analysis, kidneys from donors with a spectrum of COVID severities did not experience significantly poorer allograft outcomes over 3 years.