According to the U.S. Department of Health and Human Services,
, resulting in death or deteriorating health that makes transplantation no longer possible.
“What distinguishes this case from others is the fact that we studied the donor kidney by using pre-transplant biopsy samples to investigate the presence of the virus,” said Kyungho Lee, M.D., a Johns Hopkins Medicine fellow and first author of the manuscript.
Instead of just doing a nasal swab test on the recipient after the transplant to check for infection after the fact, researchers obtained the donor kidney tissue before transplant and studied it carefully.
Large studies are needed to confirm the validity of the molecular analysis he and his team used and to track the long-term outcome of recipients of such donor organs. Currently, there are no standardized tissue-based testing platforms or validated protocols to follow.
To test donor samples for the virus, the researchers used a standard PCR test, which amplifies genetic material from the virus, along with another sensitive technique known as in situ hybridization.
Researchers based on the limited data in the field agreed that the organ had a good chance of being used safely for the recipient, but decided to assess the risk by using precise molecular methods to evaluate infection in the donor organ.
The donor patient, the team reported, was a woman in her early 30s who was otherwise very healthy for her age, but was admitted to the hospital in March 2021 due to severe COVID-19 pneumonia and eventually placed on extracorporeal membrane oxygenation (ECMO), which is a blood pump outside the body to give oxygen to the body.
She developed hypoxic brain injury (when not enough oxygen is being supplied to the brain) and progressed to brain death. Her kidney function was stable during her hospital course, and she tested negative for the virus by nasal swab three days before donation.
Tissue samples from the donor’s kidney and aorta (a blood vessel known to have a high level of receptors for SARS-CoV-2, the virus that causes COVID-19) were collected and tested by PCR and by in situ hybridization. The samples were then compared with a separate positive COVID-19 case for accurate data interpretation. The recipient patient was a 55-year-old man with end-stage kidney disease who had been on dialysis for more than five years.
The patient had no prior COVID-19 history, was fully vaccinated, and tested negative for the virus on the day of transplantation. Since the procedure, which occurred within 24 hours of the donor’s death, the recipient has tested negative for COVID-19 by a PCR nasal swab test 20, 30, and 90 days following the transplantation, and has shown no signs or symptoms of the virus.
The recipient has been off dialysis with excellent kidney function since the transplant, says Niraj Desai, M.D., surgical director of the Kidney and Pancreas Transplant Program at Johns Hopkins Medicine.
This specific case was unique in that sophisticated tissue molecular testing was performed to provide hard data to justify using these organs and gave some measure of confidence in a safe outcome.
Decisions on whether to accept organs other than lungs from donors who have died from COVID-19-related causes should be made on a case-by-case basis.
This one case may not be representative of many possible COVID-19 donors, particularly since the donor was negative for COVID-19 at the time of transplantation.
However, it’s a step forward using highly sensitive molecular testing to show it can be safe to use organs from deceased COVID-19 donors. Organs can be individually considered for kidney transplant instead of being routinely discarded.
Source: Medindia
