The following is a summary of “Patterns in Use and Transplant Outcomes Among Adult Recipients of Kidneys From Deceased Donors With COVID-19,” published in the May 2023 issue of Nephrology by Ji et al. 

For a study, researchers aimed to determine the kidney utilization patterns and transplant outcomes in adult recipients of deceased donor kidneys with active or resolved COVID-19. This study analyzed the information from 35,851 deceased donors (71,334 kidneys) and 45,912 adult patients who underwent kidney transplantation between March 1, 2020, and March 30, 2023. 

In this study, the exposure interest was determined based on the donor’s SARS-CoV-2 nucleic acid amplification test (NAT) results, with positive NAT result within 7 days before organ procurement was considered as active COVID-19, and a positive result more than 1 week ( >7 days) before procurement was defined as resolved COVID-19.

The main outcomes assessed in this study were kidney nonuse, graft rejection, and patient mortality from any cause. Secondary outcomes were acute rejection [i.e., rejection in the first 6 months after Kidney transfer (KT)], hospitalization length of stay (LOS), and delayed graft function (DGF). They conducted multivariable logistic regression analyses to assess kidney nonuse, rejection, and DGF. Multivariable linear regression analyses were performed to evaluate the length of stay (LOS), while multivariable Cox regression analyses were performed to examine graft rejection and all-cause mortality. All models were adjusted for inverse probability treatment weighting.

Study reported out of the 35,851 deceased donors, the mean (SD) age was 42.5 (15.3) years; 22,319 (62.3%) were men, and 23 992 (66.9%) were white. Among 45,912 recipients, the mean (SD) age was 54.3 (13.2) years; 27,952 (60.9%) were men, and 15,349 (33.4%) were Black. There was a decreasing likelihood of nonuse for kidneys obtained from donors who tested positive for active or resolved COVID-19. Overall, kidneys from active COVID-19–positive donors (adjusted odds ratio [AOR], 1.55; 95% CI, 1.38-1.76) and kidneys from resolved COVID-19–positive donors (AOR, 1.31; 95% CI, 1.16-1.48) had a greater probability of nonuse compared to kidneys from donors who tested negative for COVID-19. 

From 2020 to 2022, kidneys from active COVID-19–positive donors (2020: AOR, 11.26 [95% CI, 2.29-55.38]; 2021: AOR, 2.09 [95% CI, 1.58-2.79]; 2022: AOR, 1.47 [95% CI, 1.28-1.70]) had a higher likelihood of nonuse compared with kidneys from donors without COVID-19. 

In 2020(AOR, 3.87; 95% CI, 1.26-11.90)and 2021(AOR,1.94; 95% CI, 1.54-2.45), kidneys from resolved COVID-19-positive donors had a significantly increased likelihood of nonuse but not in 2022 (AOR, 1.09; 95% CI, 0.94-1.28). There was no significant association between kidneys from active COVID-19-positive donors (AOR 1.07; 95% CI, 0.75-1.63) or resolved COVID-19-positive donors (AOR 1.18; 95% CI, 0.80-1.73) and increased odds of nonuse in 2023. Patients who received kidneys from active COVID-19-positive donors(graft failure: adjusted hazard ratio [AHR], 1.03 [95% CI, 0.78-1.37]; patient death: AHR, 1.17 [95% CI, 0.84-1.66]) or resolved COVID-19–positive donors (graft failure: AHR, 1.10 [95% CI, 0.88-1.39]; patient death: AHR, 0.95 [95% CI, 0.70-1.28]) did not exhibit a higher risk of graft failure or mortality.

The positivity of COVID-19 in donors did not show any association with longer LOS, a higher risk of acute rejection, or a higher risk of DGF. 

Study revealed a decreasing likelihood of nonuse for kidneys from COVID-19-positive donors over time. Donor COVID-19 positivity did not lead to worse KT outcomes within 2 years after transplantation. 

Investigators concluded that using kidneys from donors with active or resolved COVID-19 is safe in the medium term; more research is needed for more stable transplantation outcomes. 

Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2805378?resultClick=1