Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping?,American Journal of Transplantation

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Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping?
American Journal of Transplantation ( IF 8.9 ) Pub Date : 2021-09-01 , DOI: 10.1111/ajt.16823
Renato Romagnoli ₁ , Salvatore Gruttadauria ₂ , Giuseppe Tisone ₃ , Giuseppe Maria Ettorre ₄ , Luciano De Carlis ₅ , Silvia Martini ₆ , Francesco Tandoi ₁ , Silvia Trapani ₇ , Margherita Saracco ₆ , Angelo Luca ₂ , Tommaso Maria Manzia ₃ , Ubaldo Visco Comandini ₄ , Riccardo De Carlis ₅ , Valeria Ghisetti ₈ , Rossana Cavallo ₉ , Massimo Cardillo ₇ , Paolo Antonio Grossi ₁₀

Affiliation

Liver Transplant Center -General Surgery 2U, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
Abdominal Surgery and Organ Transplantation Unit, ISMETT, Palermo, Italy.
Surgical Sciences and Medical Sciences, University of Rome-Tor Vergata, Rome, Italy.
POIT Transplant Department, San Camillo Hospital and National Institute for Infectious Diseases L. Spallanzani, Rome, Italy.
General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca and Niguarda-Cà Granda Hospital, Milan, Italy.
Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy.
Laboratory of Microbiology and Virology, Ospedale Amedeo di Savoia, ASL "Città di Torino", Turin, Italy.
Microbiology and Virology Unit, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy.

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.

中文翻译：

来自活跃的 COVID-19 捐献者的肝移植：一个值得抓住的挽救生命的机会？

COVID-19 大流行极大地影响了移植领域。科学协会建议不要使用感染了 SARS-CoV-2 的捐献者。意大利移植管理局建议在肝移植 (LT) 前立即对接受者/捐赠者进行 SARS-CoV-2-RNA 检测，并且从 2020 年 11 月开始，允许考虑对感染了 SARS-CoV-2 的已故捐赠者进行紧急移植-需要具有活跃/已解决 COVID-19 的移植候选人。我们展示了意大利多中心系列中前 10 名活跃的 COVID-19 捐助者 LT 的结果。只有两名接受者在 LT 时进行了阳性分子检测，其中一名在 LT 后 21 天仍保持阳性。其他八名接受者在随访期间均未发现 SARS-CoV-2 呈阳性。80% (8/10) 的接受者在 LT 时针对 SARS-CoV-2 的 IgG 呈阳性，71% (5/7) 显示中和抗体，表达与近期 COVID-19 相关的保护性免疫。此外，移植时供体肝活检的 SARS-CoV-2 RNA 检测结果为 100% (9/9) 阴性，这表明 LT 传播的风险非常低。根据标准方案，免疫抑制方案保持不变。尽管病例数量很少，但这些数据表明，将来自活跃 COVID-19 的供体的肝脏移植到具有 SARS-CoV-2 免疫力的知情候选人身上，可能有助于安全地增加供体库。提示 LT 传播的风险非常低。根据标准方案，免疫抑制方案保持不变。尽管病例数量很少，但这些数据表明，将来自活跃 COVID-19 的供体的肝脏移植到具有 SARS-CoV-2 免疫力的知情候选人身上，可能有助于安全地增加供体库。提示 LT 传播的风险非常低。根据标准方案，免疫抑制方案保持不变。尽管病例数量很少，但这些数据表明，将来自活跃 COVID-19 的供体的肝脏移植到具有 SARS-CoV-2 免疫力的知情候选人身上，可能有助于安全地增加供体库。

更新日期：2021-09-01

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