Outcomes in Living Kidney Donors with Prior COVID-19

R. Prashar and colleagues at the Henry Ford Transplant Institute, Detroit, Michigan, performed an analysis to examine short-term outcomes among living kidney donors who were previously infected with COVID-19 as well as outcomes in recipients of kidneys from those donors. Results of the analysis were reported during a virtual presentation at the 2021 American Transplant Congress. The presentation was titled Short-Term Outcomes in Previously COVID Positive Living Kidney Donors and Their Recipients.

Following a brief COVID-19 related hiatus in transplants from March 2020 to May 2020, the institute performed 33 living donor transplants as of the date of the presentation. Of those, the researchers identified three consecutive living kidney donors who were diagnosed with COVID-19 prior to transplant. The analysis included retrospective data on clinical characteristics for donors and recipients.

The transplants were approved following meeting the institutional requirements of resolution of COVID. COVID-19 resolution requirements for both donors and recipients were negative nasopharyngeal testing by nucleic acid test for SARS-CoV-2 at 28 days after resolution of COVID-19 symptoms and a repeat negative test 48 hours prior to transplant.

Mean time from COVID-19 diagnosis to donation was 56 days. All donors had mild disease that did not require hospitalization; none had hematuria or proteinuria prior to donation. With the exception of expected initial decline in estimated glomerular filtration rate, the post-donation course was uncomplicated in all three donors. Findings in post-perfusion biopsy in donor 2 showed an incidental finding of immunoglobin A nephropathy (Oxford classification 0). There were no viral particles on electron microscopy.

In recipient #2, there was patchy podocyte foot process effacement, believed to be due to recurrence of focal segmental glomerulosclerosis (FSGS). Recipient #1 had COVID-19 prior to transplantation. The post-transplant course was uneventful in two of the three recipients. Recipient #2 developed recurrence of FSGS immediately post-transplant; her course was further complicated by mild COVID-19 on day 7 following transplant. Her COVID-19 was managed by reduction in immunosuppression, bamlanivimab, steroids, and remdesivir. The exact COVID exposure for patient #2 is not known; she appears to have contracted it from the community.

In conclusion, the researchers said, “Living kidney donors with previously resolved COVID-19 appear to have an uncomplicated immediate post-donation course. Recipients of living kidney donors with resolved COVID tend to do well. Questions remain regarding optimal timing of donation and transplant after COVID resolution to minimize risk of SARS-CoV-2 transmission through tissue, even with negative nasopharyngeal PCR [polymerase chain reaction].”

Source: Prashar R, Khoury N J , Ramesh M, Patel A K. Short term outcomes in previously COVID positive living kidney donors and their recipients. Abstract of a presentation at the virtual 2021 American Transplant Congress (Abstract #LB 54), June 5, 2021.