Should We Transplant Candidates With a Positive SARS-CoV-2 RT-PCR Test?
Ilies Benotmane, Nathan Kasriel, Christophe Masset, Baptiste Michard, Paolo Malvezzi, Baptiste Giguet, Claire Tinel, Filomena Conti, Florent Von Tokarski, José Ursic-Bedoya, Marie Matignon, Adrien Flahault, Inna Mohamadou, Fanny Lebossé, Nassim Kamar, Mehdi Maanaoui, Ilias Kounis, Coralie Poulain, Marie-Noëlle Hilleret, Dany Anglicheau, Florence Lacaille, Nicolas Bouvier, Léonard Golbin, Agnès Duveau, Sophie Caillard, Lionel Couzi, Hannah Kaminski, Jérôme DumortierBackground.
It remains unclear whether physicians should accept transplantation offers for candidates with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test due to the potential risk of severe infection after initiating immunosuppressive therapy.
Methods.
A multicenter observational study was conducted in 19 French solid organ transplantation units. Patients on the waiting list for liver or kidney transplants who had a positive SARS-CoV-2 reverse transcription polymerase chain reaction nasopharyngeal swab at the time of transplantation were recorded.
Results.
Sixty-five patients were included. The recipients were predominantly men (n = 40; 62%) with a mean age of 55.4 y (SD = 16.5). On the day of transplantation, 2 patients exhibited symptoms compatible with COVID-19. The majority of patients (n = 55; 85%) underwent thoracic imaging, with only 3 patients showing imaging results compatible with COVID-19. Ten patients (28%) had a cycle threshold value <30. Anti–SARS-CoV-2 spike protein serology within 3 mo before transplantation was available for 36 patients; only 2 patients were seronegative. Due to COVID-19, physicians adapted the immunosuppressive therapy for 16 patients (25%). Specific antiviral therapy was used for 15 patients (23%), primarily remdesivir (n = 12). Overall, the majority of patients did not receive any adjustment of immunosuppressive therapy or antiviral treatment (n = 36; 55%). The outcomes were generally favorable even for patients with the lowest cycle threshold values, indicating a high viral load. Four patients died during follow-up, although none of these deaths were attributable to COVID-19.
Conclusions.
Transplantation appears to be safe for patients who are asymptomatic or have mild symptoms, reassuring thoracic imaging, and a history of anti–SARS-CoV-2 infection and/or immunization.