Kidney Transplant Function in Recipients from Deceased Donors with COVID-19

Background: During the COVID-19 pandemic, uncertainty regarding the safety of kidneys from COVID-19-positive donors led to a reduction in kidney transplants and increased organ non-use in the United States. This study aims to evaluate whether donor COVID-19 positivity is associated with one-year post-transplant estimated glomerular filtration rate (eGFR) among kidney transplant recipients. Methods: This retrospective cohort study used data from the United States Organ Procurement and Transplantation Network (OPTN) 2020-2024. Donor COVID-19 status was determined by the SARS-CoV-2 nucleic acid amplification technique (NAT) and antibody test results. The main outcome was recipients' one-year eGFR, estimated by the CKD-EPI 2021 formula. Linear regression models were used to compare the mean one-year eGFR among donor COVID-19 groups, adjusted by inverse probability of treatment weights. Interaction terms of donor acute kidney injury status and race were assessed to evaluate effect modification. Results: Among 38,199 included kidney transplant recipients, 1090 (2.9%) received kidneys from donors with active COVID-19 infection, 423 (1.1%) from donors with resolved infection, and 36,686 (96.0%) from COVID-19-negative donors. After weighting and adjustment, there was no significant difference in one-year eGFR for recipients of kidneys from donors with active COVID-19 (mean difference, 0.05 [95% CI, -1.08 to 1.18]) or resolved infection (mean difference, -0.27 [95% CI, -2.19 to 1.64]) compared with COVID-19-negative donors. Neither donor AKI nor donor race modified the association between donor COVID-19 status and one-year eGFR. Conclusions: This study suggests that kidneys from COVID-19-positive donors may be a viable option without compromising short-term allograft function as measured by 1-year eGFR.