TY - JOUR
T1 - Liver transplantation from active COVID-19 donors
T2 - A lifesaving opportunity worth grasping?
AU - Romagnoli, Renato
AU - Gruttadauria, Salvatore
AU - Tisone, Giuseppe
AU - Maria Ettorre, Giuseppe
AU - De Carlis, Luciano
AU - Martini, Silvia
AU - Tandoi, Francesco
AU - Trapani, Silvia
AU - Saracco, Margherita
AU - Luca, Angelo
AU - Maria Manzia, Tommaso
AU - Visco Comandini, Ubaldo
AU - De Carlis, Riccardo
AU - Ghisetti, Valeria
AU - Cavallo, Rossana
AU - Cardillo, Massimo
AU - Grossi, Paolo Antonio
N1 - Publisher Copyright:
© 2021 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021
Y1 - 2021
N2 - COVID-19 pandemic dramatically impacted transplantation landscape. Scientific societies recommend against the use of donors with active SARS-CoV-2 infection. Italian Transplant Authority recommended to test recipients/donors for SARS-CoV-2-RNA immediately before liver transplant (LT) and, starting from November 2020, grafts from deceased donors with active SARS-CoV-2 infection were allowed to be considered for urgent-need transplant candidates with active/resolved COVID-19. We present the results of the first 10 LTs with active COVID-19 donors within an Italian multicenter series. Only two recipients had a positive molecular test at LT and one of them remained positive up to 21 days post-LT. None of the other eight recipients was found to be SARS-CoV-2 positive during follow-up. IgG against SARS-CoV-2 at LT were positive in 80% (8/10) of recipients, and 71% (5/7) showed neutralizing antibodies, expression of protective immunity related to recent COVID-19. In addition, testing for SARS-CoV-2 RNA on donors’ liver biopsy at transplantation was negative in 100% (9/9), suggesting a very low risk of transmission with LT. Immunosuppression regimen remained unchanged, according to standard protocol. Despite the small number of cases, these data suggest that transplanting livers from donors with active COVID-19 in informed candidates with SARS-CoV-2 immunity, might contribute to safely increase the donor pool.
AB - COVID-19 pandemic dramatically impacted transplantation landscape. Scientific societies recommend against the use of donors with active SARS-CoV-2 infection. Italian Transplant Authority recommended to test recipients/donors for SARS-CoV-2-RNA immediately before liver transplant (LT) and, starting from November 2020, grafts from deceased donors with active SARS-CoV-2 infection were allowed to be considered for urgent-need transplant candidates with active/resolved COVID-19. We present the results of the first 10 LTs with active COVID-19 donors within an Italian multicenter series. Only two recipients had a positive molecular test at LT and one of them remained positive up to 21 days post-LT. None of the other eight recipients was found to be SARS-CoV-2 positive during follow-up. IgG against SARS-CoV-2 at LT were positive in 80% (8/10) of recipients, and 71% (5/7) showed neutralizing antibodies, expression of protective immunity related to recent COVID-19. In addition, testing for SARS-CoV-2 RNA on donors’ liver biopsy at transplantation was negative in 100% (9/9), suggesting a very low risk of transmission with LT. Immunosuppression regimen remained unchanged, according to standard protocol. Despite the small number of cases, these data suggest that transplanting livers from donors with active COVID-19 in informed candidates with SARS-CoV-2 immunity, might contribute to safely increase the donor pool.
KW - cirrhosis
KW - clinical research/practice
KW - donors and donation: deceased
KW - donors and donation: donor evaluation
KW - donors and donation: donor-derived infections
KW - ethics and public policy
KW - infection and infectious agents - viral
KW - infectious disease
KW - liver transplantation/hepatology
KW - organ procurement and allocation
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U2 - 10.1111/ajt.16823
DO - 10.1111/ajt.16823
M3 - Article
AN - SCOPUS:85114708424
SP - 1
EP - 7
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
ER -