Should We Transplant Candidates With a Positive SARS-CoV-2 RT-PCR Test?

Abstract

Background. 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.