Solid Organ Transplants in Patients after COVID-19

Due to the continuing COVID-19 pandemic, it is important to determine the safety and timing of proceeding with solid organ transplantation in transplant candidates who have recovered form SARS-CoV-2 infection and are otherwise eligible for transplant. Vivek Kute, MD, and colleagues conducted a review of current protocols and outcomes of solid organ transplantation in patients who have recovered from SARS-CoV-2 infection [Current Transplantation Reports. doi.1007/s40472-022-00362-5].

The researchers identified 44 published reports through September 7, 2021. The reports represented 183 solid organ transplants: 115 kidney transplants, 27 lung transplants, 36 liver transplants, three heart transplants, one simultaneous pancreas-kidney transplant, and one small bowel transplant. The majority of the transplants involved a living donor.

A positive SARS-CoV-2 antibody test was not obligatory in most reports; however, a positive test was a useful tool in the decision to proceed with the transplant. In many reports, a key prerequisite for transplant was two consecutive real-time polymerase chain reaction (RT-PCR) negative tests. Some reports suggested that transplantation can proceed in select circumstances without waiting for a negative RT-PCR. In general, there were no changes in standard immunosuppression regimens.

In summary, the authors said, “In select cases, solid organ transplantation in COVID-19 recovered patients appears successful in short-term follow-up. Emergency solid organ transplantation can be performed with active SARS-CoV-2 infection in some cases. In general, continuing standard immunosuppression regimen may be reasonable, except in cases of inadvertent transplantation with active SARS-CoV-2. Available reports are predominantly in kidney transplant recipients, and more data for other organ transplants are needed.”